Predictive utility of mortality of the rapid scale of emergencies (REMS) in a Hospital of high complexity

Utilidad predictiva de mortalidad de la escala rápida de emergencias (REMS) en un Hospital de alta complejidad.

Objective: to test the Rapid Emergency Medicine Score (REMS) utility as a predictor in terms of in-hospital mortality and hospital stay in adult surgical and non-surgical patients admitted to the emergency department (ED) of Hospital de San José in Bogotá. Method: this was an analytic retrospective study including patients admitted to a fourth level hospital in Bogotá, Colombia ED, between September 2016 and February 2017. Results: 1080 patients were randomly included obtaining an in-hospital mortality rate of 10.19% (n: 110), median age of nonsurvivors 73 years vs 55 years of survivors. The estimated median REMS was significantly higher in the in-hospital nonsurvivors group 7 (5-10) than that in the survivors group 3 (0-3). A logistic regression analysis demonstrated variables most related with in-hospital death were: days of hospital stay (OR: 1.08 95% CI 1.04 to 1.12), REMS (OR: 1.5 95% CI 1.34 to 1.7), immunocompromised state (OR: 6.27 95% CI 2.12 to 18.5) and oncologic pathology (OR 12 95% 6.25 to 26.6). The mortality cut off point for the scale was 6. An OR of 4.3 (95% CI 2.3 to 8) was obtained considering the other variables that impacted mortality. The discriminatory power of the area under the curve (AUC) value of 0.97 was considered good. Conclusions: in our population REMS was a good predictor tool of in-hospital mortality in surgical and non-surgical patients admitted to the ED, and was considered a good tool for clinical decision making, classification and resource use. This score could not be employed to discriminate trauma patients due to the sample size. Considering the analysis of other variables, a new scale including REMS may be developed including associated statistically significant variables.

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