Introduction: Rapid acute physiology score (RAPS) and rapid emergency medicine score (REMS) are two physiologic models for measuring injury severity in emergency settings. The present study was designed to compare the two models in outcome prediction of trauma patients presenting to emergency department (ED).
Methods: In this prospective cross-sectional study, the two models of RAPS and REMS were compared regarding prediction of mortality and poor outcome (severe disability based on Glasgow outcome scale) of trauma patients presenting to the EDs of 5 educational hospitals in Iran (Tehran, Tabriz, Urmia, Jahrom and Ilam) from May to October 2016. The discriminatory power and calibration of the models were calculated and compared using STATA 11.
Results: 2148 patients with the mean age of 39.50±17.27 years were studied (75.56% males). The area under the curve of REMS and RAPS in predicting in-hospital mortality were calculated to be 0.93 (95% CI: 0.92-0.95) and 0.899 (95% CI: 0.86-0.93), respectively (p=0.02). These measures were 0.92 (95% CI: 0.90-0.94) and 0.86 (95% CI: 0.83-0.90), respectively, regarding poor outcome (p=0.001). The optimum cut-off point in predicting outcome was found to be 3 for REMS model and 2 for RAPS model. The sensitivity and specificity of REMS and RAPS in the mentioned cut offs were 95.93 vs. 85.37 and 77.63 vs. 83.51, respectively, in predicting mortality. Calibration and overall performance of the two models were acceptable.Conclusion: The present study showed that adding age and level of arterial oxygen saturation to the variables included in RAPS model can increase its predictive value. Therefore, it seems that REMS could be used for predicting mortality and poor outcome of trauma patients in emergency settings
Meheš M, Abdullah F. Global Surgery and Public Health: A New Paradigm. Archives of Surgery. 2011;146(10):1218-9.
Mathers CD, Loncar D. Projections of Global Mortality and Burden of Disease from 2002 to 2030. PLoS Med. 2006;3(11):e442.
Shortell SM, Zimmerman JE, Rousseau DM, Gillies RR, Wagner DP, Draper EA, et al. The performance of intensive care units: does good management make a difference? Medical care. 1994:508-25.
Hosseini M, Ghelichkhani P, Baikpour M, Tafakhori A, Asady H, Ghanbari MJH, et al. Diagnostic Accuracy of Ultrasonography and Radiography in Detection of Pulmonary Contusion; a Systematic Review and Meta-Analysis. Emergency. 2015;3(4):127-36.
Rahimi-Movaghar V, Yousefifard M, Ghelichkhani P, Baikpour M, Tafakhori A, Asady H, et al. Application of Ultrasonography and Radiography in Detection of Hemothorax; a Systematic Review and Meta-Analysis. Emergency. 2016;4(3):116-26.
Rahimi-Movaghar V, Yousefifard M, Ghelichkhani P, Baikpour M, Tafakhori A, Asady H, et al. Application of Ultrasonography and Radiography in Detection of Hemothorax: a Systematic Review and Meta-Analysis. EMERGENCY-An Academic Emergency Medicine Journal. 2016;4(3):116-26.
Safari S, Yousefifard M, Baikpour M, Rahimi-Movaghar V, Abiri S, Falaki M, et al. Validation of thoracic injury rule out criteria as a decision instrument for screening of chest radiography in blunt thoracic trauma. Journal of clinical orthopaedics and trauma. 2016;7(2):95-100.
Safari S, Yousefifard M, Hashemi B, Baratloo A, Forouzanfar MM, Rahmati F, et al. The value of serum creatine kinase in predicting the risk of rhabdomyolysis-induced acute kidney injury: a systematic review and meta-analysis. Clinical and experimental nephrology. 2016;20(2):153-61.
Yousefifard M, Baikpour M, Ghelichkhani P, Asady H, Darafarin A, Amini Esfahani MR, et al. Comparison of Ultrasonography and Radiography in Detection of Thoracic Bone Fractures; a Systematic Review and Meta-Analysis. Emergency. 2016;4(2):55-64.
Yousefifard M, Baikpour M, Ghelichkhani P, Asady H, Darafarin A, Esfahani MRA, et al. Comparison of Ultrasonography and Radiography in Detection of Thoracic Bone Fractures; a Systematic Review and Meta-Analysis. Emergency. 2016;4(2):55-64.
Yousefifard M, Baikpour M, Ghelichkhani P, Asady H, Nia KS, Jafari AM, et al. Screening Performance Characteristic of Ultrasonography and Radiography in Detection of Pleural Effusion; a Meta-Analysis. Emergency. 2015;3(4):127–36.
de Souza Nogueira L, de Alencar Domingues C, Poggetti RS, de Sousa RMC. Nursing workload in intensive care unit trauma patients: analysis of associated factors. PloS one. 2014;9(11):e112125.
Staff T, Eken T, Wik L, Røislien J, Søvik S. Physiologic, demographic and mechanistic factors predicting New Injury Severity Score (NISS) in motor vehicle accident victims. Injury. 2013;[In press].
Kumagai G, Tsoulfas P, Toh S, McNiece I, Bramlett HM, Dietrich WD. Genetically modified mesenchymal stem cells (MSCs) promote axonal regeneration and prevent hypersensitivity after spinal cord injury. Experimental neurology. 2013;248:369-80.
Morgan R, Williams F, Wright M. An early warning scoring system for detecting developing critical illness. Clin Intensive Care. 1997;8(2):100.
de Pennington J, Laurenson J, Lebus C, Sihota S, Smith P. Evaluation of early warning systems on a medical admissions unit. Journal of the Intensive Care Society. 2005;6(2):19-21.
Goldhill D. Preventing surgical deaths: critical care and intensive care outreach services in the postoperative period. British journal of anaesthesia. 2005;95(1):88-94.
Williams E, Subbe C, Gemmell L, Morgan R, Park G, McElligot M, et al. Outreach critical care—cash for no questions? British journal of anaesthesia. 2003;90(5):699-702.
Olsson T, Lind L. Comparison of the Rapid Emergency Medicine Score and APACHE II in Nonsurgical Emergency Department Patients. Academic Emergency Medicine. 2003;10(10):1040-8.
Olsson T, Terent A, Lind L. Rapid Emergency Medicine Score Can Predict Long-term Mortality in Nonsurgical Emergency Department Patients. Academic Emergency Medicine. 2004;11(10):1008-13.
Anderson SI, Housley AM, Jones PA, Slattery J, Miller JD. Glasgow Outcome Scale: an inter-rater reliability study. Brain Injury. 1993;7(4):309-17.
Imhoff BF, Thompson NJ, Hastings MA, Nazir N, Moncure M, Cannon CM. Rapid Emergency Medicine Score (REMS) in the trauma population: a retrospective study. BMJ Open. 2014;4(5).
Cleves MA, Rock L. From the help desk: Comparing areas under receiver operating characteristic curves from two or more probit or logit models. The Stata Journal. 2002;2(3):301-13.
Olsson T, Terént A, Lind L. Rapid Emergency Medicine Score: a new prognostic tool for in‐hospital mortality in nonsurgical emergency department patients. Journal of internal medicine. 2004;255(5):579-87.
Olsson T, Terent A, Lind L. Charlson Comorbidity Index can add prognostic information to Rapid Emergency Medicine Score as a predictor of long-term mortality. European Journal of Emergency Medicine. 2005;12(5):220-4.
Kuo S-H, Tsai C-F, Li C-R, Tsai S-J, Chao W-N, Chan K-S, et al. Rapid Emergency Medicine Score as a main predictor of mortality in Vibrio vulnificus–related patients. The American Journal of Emergency Medicine. 2013;31(7):1037-41.
Ha DT, Dang TQ, Tran NV, Vo NY, Nguyen ND, Nguyen TV. Prognostic performance of the Rapid Emergency Medicine Score (REMS) and Worthing Physiological Scoring system (WPS) in emergency department. International journal of emergency medicine. 2015;8(1):18.
Bulut M, Cebicci H, Sigirli D, Sak A, Durmus O, Top AA, et al. The comparison of modified early warning score with rapid emergency medicine score: a prospective multicentre observational cohort study on medical and surgical patients presenting to emergency department. Emergency Medicine Journal. 2013:emermed-2013-202444.
Lefering R. Trauma scoring systems. Current opinion in critical care. 2012;18(6):637-40.