The utility of the Rapid Emergency Medicine Score (REMS) compared with three other early warning scores in predicting in-hospital mortality among COVID-19 patients in the emergency department: a multicenter validation study.

BACKGROUND: Many early warning scores (EWSs) have been validated to prognosticate adverse outcomes of COVID-19 in the Emergency Department (ED), including the quick Sequential Organ Failure Assessment (qSOFA), the Modified Early Warning Score (MEWS), and the National Early Warning Score (NEWS). However, the Rapid Emergency Medicine Score (REMS) has not been widely validated for this purpose. We aimed to assess and compare the prognostic utility of REMS with that of qSOFA, MEWS, and NEWS for predicting mortality in emergency COVID-19 patients. METHODS: We conducted a multi-center retrospective study at five EDs of various levels of care in Thailand. Adult patients visiting the ED who tested positive for COVID-19 prior to ED arrival or within the index hospital visit between January and December 2021 were included. Their EWSs at ED arrival were calculated and analysed. The primary outcome was all-cause in-hospital mortality. The secondary outcome was mechanical ventilation. RESULTS: A total of 978 patients were included in the study; 254 (26%) died at hospital discharge, and 155 (15.8%) were intubated. REMS yielded the highest discrimination capacity for in-hospital mortality (the area under the receiver operator characteristics curves (AUROC) 0.771 (95% confidence interval (CI) 0.738, 0.804)), which was significantly higher than qSOFA (AUROC 0.620 (95%CI 0.589, 0.651); p < 0.001), MEWS (AUROC 0.657 (95%CI 0.619, 0.694); p < 0.001), and NEWS (AUROC 0.732 (95%CI 0.697, 0.767); p = 0.037). REMS was also the best EWS in terms of calibration, overall model performance, and balanced diagnostic accuracy indices at its optimal cutoff. REMS also performed better than other EWSs for mechanical ventilation. CONCLUSION: REMS was the early warning score with the highest prognostic utility as it outperformed qSOFA, MEWS, and NEWS in predicting in-hospital mortality in COVID-19 patients in the ED.

Evaluation of Early Warning Scores on In-Hospital Mortality in COVID-19 Patients: A Tertiary Hospital Study from Taiwan.

Coronavirus disease 2019 (COVID-19) remains a global pandemic. Early warning scores (EWS) are used to identify potential clinical deterioration, and this study evaluated the ability of the Rapid Emergency Medicine score (REMS), National Early Warning Score (NEWS), and Modified EWS (MEWS) to predict in-hospital mortality in COVID-19 patients. This study retrospectively analyzed data from COVID-19 patients who presented to the emergency department and were hospitalized between 1 May and 31 July 2021. The area under curve (AUC) was calculated to compare predictive performance of the three EWS. Data from 306 COVID-19 patients (61 ± 15 years, 53% male) were included for analysis. REMS had the highest AUC for in-hospital mortality (AUC: 0.773, 95% CI: 0.69-0.85), followed by NEWS (AUC: 0.730, 95% CI: 0.64-0.82) and MEWS (AUC: 0.695, 95% CI: 0.60-0.79). The optimal cut-off value for REMS was 6.5 (sensitivity: 71.4%; specificity: 76.3%), with positive and negative predictive values of 27.9% and 95.4%, respectively. Computing REMS for COVID-19 patients who present to the emergency department can help identify those at risk of in-hospital mortality and facilitate early intervention, which can lead to better patient outcomes.

Evaluating the Mortality Rates of COVID-19 Patients in the Intensive Care Unit Using the Rapid Emergency Medicine Score, Acute Physiology and Chronic Health Assessment-II, Charlson Comorbidity Index and Sequential Organ Failure Assessment Scoring Models

Introduction: Four scoring models, including the Rapid Emergency Medicine Score (REMS), Charlson Comorbidity Index (CCI), Acute Physiology and Chronic Health Assessment-II (APACHE-II), and Sequential Organ Failure Assessment (SOFA), were examined. The effectiveness of these scores in mortality prediction of intensive care unit (ICU)-admitted Coronavirus disease-2019 (COVID-19) patients was investigated. Materials and Methods: The present retrospective analysis was conducted in a single center among patients with confirmed or suspected COVID-19 diagnosis who were admitted to emergency department and then ICU between March and December 2020. The REMS, APACHE-II, CCI, and SOFA were used to evaluate the mortality associated factors. Results: The sample included 411 patients above 18 years of age, with a median age of 71 (interquartile range: 60-80), and made up of 61.6% males. High creatinine, potassium, fraction of inspired oxygen and white blood cell levels as well as low hematocrit levels, pH, mean arterial pressure, and systolic and diastolic blood pressure accounted for a poor prognosis. Statistically significant differences were determined between laboratory values and physiological findings (p<0.05). Comorbidity was found in 368 (89.5%) patients while malignancy and dementia were significantly associated to mortality (p<0.001 and 0.019, respectively). The scoring systems are clearly among the important indicators of in-hospital mortality (p<0.001). Additionally, the receiver operating curve analysis did not reveal significant differences in the scoring systems when considered in terms of discriminative power (p>0.05). Conclusion: The results revealed the effectiveness of REMS, CCI, APACHE-II, and SOFA in the prediction of critical COVID-19 patients' in-hospital mortality;but none of the scoring systems prevailed over others. Therefore, the REMS, APACHE-II, CCI, and SOFA scoring models can guide not only emergency physicians but also all clinicians who contribute to the management of critical COVID-19 cases.