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Prognostic performance of the Rapid Emergency Medicine Score (REMS) and Worthing Physiological Scoring system (WPS) in emergency department.

Ha DT, Dang TQ, Tran NV, Vo NY, Nguyen ND, Nguyen TV - Int J Emerg Med (2015)

Bottom Line: The primary outcome was mortality within 30 days since hospitalization.The AUC of the REMS was 0.71 (95 % CI: 0.67-0.76) which was significantly lower than that of the WPS (0.80; 95 % CI: 0.76-0.83).The WPS appeared to have a better prognostic performance than the REMS system.

View Article: PubMed Central - PubMed

Affiliation: Intensive Care Unit, National Hospital of Can Tho, Can Tho City, Vietnam ; Ton Duc Thang University, Ho Chi Minh City, Vietnam.

ABSTRACT

Background: The Rapid Emergency Medicine Score (REMS) and Worthing Physiological Scoring system (WPS) have been developed for predicting in-hospital mortality in nonsurgical emergency department (ED) patients. The prognostic performance of the scoring systems in independent populations has not been clear. The aim of the study is to evaluate the prognostic accuracy of REMS and WPS systems in the estimation of 30-day mortality risk among medical patients in ED.

Methods: The study was designed as a prospective investigation, with the setting being the ED of the National Hospital of Can Tho, Vietnam. We enrolled medical patients aged 16+ years who met the study entry criteria. Clinical data were obtained as required for each scoring system. The primary outcome was mortality within 30 days since hospitalization. The association between each scoring system and mortality was assessed by the hazard ratio (HR) of the Cox's proportional hazard model.

Results: The study involved 1746 patients, average age 65.9 years (SD 17). During the period of follow-up, 172 patients (9.9 %) died. The risk of 30-day mortality was increased by 30 % for each additional REMS unit (HR: 1.28; 95 % confidence interval (CI): 1.23-1.34) and by 60 % for each additional WPS unit (HR: 1.6; 95 % CI: 1.5-1.7). The AUC of the REMS was 0.71 (95 % CI: 0.67-0.76) which was significantly lower than that of the WPS (0.80; 95 % CI: 0.76-0.83).

Conclusions: Both REMS and WPS have good prognostic value in the prediction of death in ED patients. The WPS appeared to have a better prognostic performance than the REMS system.

No MeSH data available.


Concordance between REMS predicted and WPS predicted percent of mortality
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Fig4: Concordance between REMS predicted and WPS predicted percent of mortality

Mentions: In the Cox’s proportional hazards model, each unit increase in the REMS was associated with 30 % increase in the risk of mortality (HR 1.28; 95 % CI: 1.23–1.34), and each unit increase in WPS was associated with a 60 % risk of mortality (HR 1.6; 95 % CI: 1.5–1.7). The area under the receiver operating characteristic curve for REMS and WPS in mortality prediction is shown in Fig. 3. The AUC for WPS (0.797) was significantly greater than that for REMS (0.712). In addition, there was a modest correlation between the predicted risk of mortality by REMS and predicted risk of mortality by WPS (Fig. 4), with the Spearman’s rank correlation being 0.45 (P < 0.001).Fig. 3


Prognostic performance of the Rapid Emergency Medicine Score (REMS) and Worthing Physiological Scoring system (WPS) in emergency department.

Ha DT, Dang TQ, Tran NV, Vo NY, Nguyen ND, Nguyen TV - Int J Emerg Med (2015)

Concordance between REMS predicted and WPS predicted percent of mortality
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4457731&req=5

Fig4: Concordance between REMS predicted and WPS predicted percent of mortality
Mentions: In the Cox’s proportional hazards model, each unit increase in the REMS was associated with 30 % increase in the risk of mortality (HR 1.28; 95 % CI: 1.23–1.34), and each unit increase in WPS was associated with a 60 % risk of mortality (HR 1.6; 95 % CI: 1.5–1.7). The area under the receiver operating characteristic curve for REMS and WPS in mortality prediction is shown in Fig. 3. The AUC for WPS (0.797) was significantly greater than that for REMS (0.712). In addition, there was a modest correlation between the predicted risk of mortality by REMS and predicted risk of mortality by WPS (Fig. 4), with the Spearman’s rank correlation being 0.45 (P < 0.001).Fig. 3

Bottom Line: The primary outcome was mortality within 30 days since hospitalization.The AUC of the REMS was 0.71 (95 % CI: 0.67-0.76) which was significantly lower than that of the WPS (0.80; 95 % CI: 0.76-0.83).The WPS appeared to have a better prognostic performance than the REMS system.

View Article: PubMed Central - PubMed

Affiliation: Intensive Care Unit, National Hospital of Can Tho, Can Tho City, Vietnam ; Ton Duc Thang University, Ho Chi Minh City, Vietnam.

ABSTRACT

Background: The Rapid Emergency Medicine Score (REMS) and Worthing Physiological Scoring system (WPS) have been developed for predicting in-hospital mortality in nonsurgical emergency department (ED) patients. The prognostic performance of the scoring systems in independent populations has not been clear. The aim of the study is to evaluate the prognostic accuracy of REMS and WPS systems in the estimation of 30-day mortality risk among medical patients in ED.

Methods: The study was designed as a prospective investigation, with the setting being the ED of the National Hospital of Can Tho, Vietnam. We enrolled medical patients aged 16+ years who met the study entry criteria. Clinical data were obtained as required for each scoring system. The primary outcome was mortality within 30 days since hospitalization. The association between each scoring system and mortality was assessed by the hazard ratio (HR) of the Cox's proportional hazard model.

Results: The study involved 1746 patients, average age 65.9 years (SD 17). During the period of follow-up, 172 patients (9.9 %) died. The risk of 30-day mortality was increased by 30 % for each additional REMS unit (HR: 1.28; 95 % confidence interval (CI): 1.23-1.34) and by 60 % for each additional WPS unit (HR: 1.6; 95 % CI: 1.5-1.7). The AUC of the REMS was 0.71 (95 % CI: 0.67-0.76) which was significantly lower than that of the WPS (0.80; 95 % CI: 0.76-0.83).

Conclusions: Both REMS and WPS have good prognostic value in the prediction of death in ED patients. The WPS appeared to have a better prognostic performance than the REMS system.

No MeSH data available.