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Donoso Calero MI, Mordillo-Mateos L, Martín-Conty JL, Polonio-López B, López-González Á, Durantez-Fernández C, Viñuela A, Rodríguez Hernández M, Mohedano-Moriano A, López-Izquierdo R, Jorge Soto C, Martín-Rodríguez F. Modified Rapid Emergency Medicine Score-Lactate (mREMS-L) performance to screen non-anticipated 30-day-related-mortality in emergency department. Eur J Clin Invest 2023; 53:e13994. [PMID: 37000120 DOI: 10.1111/eci.13994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/28/2023] [Accepted: 03/23/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND The aim of this study was to compare the ability to predict 30-day in-hospital mortality of lactate versus the modified Rapid Emergency Medicine Score (mREMS) versus the arithmetic sum of the mREMS plus the numerical value of lactate (mREMS-L). METHODS A prospective, multicentric, emergency department delivery, pragmatic study was conducted. To determine the predictive capacity of the scales, lactate was measured and the mREMS and mREMS-L were calculated in adult patients (aged>18 years) transferred with high priority by ambulance to the emergency department in five hospitals of Castilla y Leon between 1 January 2020 and 31 December 2021. The area under the receiver operating characteristic (ROC) curve of each of the scales was calculated in terms of mortality for 30 days. RESULTS A total of 5371 participants were included, and the in-hospital mortality rate at 30 days was of 11.4% (615 cases). The best cut-off point determined in the mREMS was 7.0 points (sensitivity of 67% and specificity of 84%), and for lactate, the cut-off point was 1.4 mmol/L (sensitivity of 88% and specificity of 67%). Finally, the combined mREMS-L showed a cut-off point of 7.9 (sensitivity of 83% and a specificity of 83%). The area under the ROC curve of the mREMS, lactate and mREMS-L for 30-day mortality was 0.851, 0.853, and 0.903, respectively (p < 0.001 in all cases). CONCLUSIONS The new score generated, mREMS-L, obtained better statistical results than its components (mREMS and lactate) separately.
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Affiliation(s)
- M Isabel Donoso Calero
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain
| | - Laura Mordillo-Mateos
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain
- Technological Innovation Applied to Health Research Group (ITAS), Faculty of Health Sciences, University of Castilla La Mancha, Talavera de la Reina, Spain
| | - José L Martín-Conty
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain
- Technological Innovation Applied to Health Research Group (ITAS), Faculty of Health Sciences, University of Castilla La Mancha, Talavera de la Reina, Spain
| | - Begoña Polonio-López
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain
- Technological Innovation Applied to Health Research Group (ITAS), Faculty of Health Sciences, University of Castilla La Mancha, Talavera de la Reina, Spain
| | - Ángel López-González
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Nursing, University of Castilla-La Mancha, Albacete, Spain
| | | | - Antonio Viñuela
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain
- Technological Innovation Applied to Health Research Group (ITAS), Faculty of Health Sciences, University of Castilla La Mancha, Talavera de la Reina, Spain
| | - Marta Rodríguez Hernández
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain
- Technological Innovation Applied to Health Research Group (ITAS), Faculty of Health Sciences, University of Castilla La Mancha, Talavera de la Reina, Spain
| | - Alicia Mohedano-Moriano
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain
- Technological Innovation Applied to Health Research Group (ITAS), Faculty of Health Sciences, University of Castilla La Mancha, Talavera de la Reina, Spain
| | | | - Cristina Jorge Soto
- Faculty of Nursing, University of Santiago de Compostela, Santiago de Compostela, Spain
- CLINURSID Research Group, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Francisco Martín-Rodríguez
- Advanced Life Support, Gerencia de Emergencias Sanitarias, Gerencia Regional de Salud de Castilla y León (SACYL), Valladolid, Spain
- Advanced Clinical Simulation Centre, Faculty of Medicine, University of Valladolid, Valladolid, Spain
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Garkaz O, Rezazadeh F, Golfiroozi S, Paryab S, Nasiri S, Mehryar H, Ghelichi-Ghojogh M. Predicting the 28-Day Mortality of Non-Trauma Patients using REMS and RAPS; a Prognostic Accuracy Study. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2022; 10:e52. [PMID: 36033985 PMCID: PMC9397601 DOI: 10.22037/aaem.v10i1.1601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction Various scoring systems have been designed for calculating the mortality risk of patients. This study evaluated the accuracy of Rapid Emergency Medicine Score (REMS) and Rapid Acute Physiology Score (RAPS) in predicting the 28-day mortality of non-trauma patients. Methods This prospective cross-sectional study was conducted on 1003 adult non-trauma patients, who referred to the emergency department of Imam Khomeini Hospital, Urmia, Iran, in the second half of 2018, using the census sampling. We determined the screening performance characteristics of REMS and RAPS in predicting the 28-day mortality of patients. Results This study examined 1003 non-trauma patients with a mean age of 61.5±18.05 years (60.6% male). The mean REMS (8.7 ± 3.2 vs. 6.0 ± 3.6; p < 0.001) and RAPS (3.7 ± 2.8 vs. 2.7 ± 2.0; p < 0.001) scores were significantly higher in deceased cases. Sensitivity and specificity of REMS in predicting the risk of non-trauma patients' mortality were 85.19% (95%CI: 78.05% - 90.71%) and 78.34% (95%CI: 75.45% - 81.04%), respectively. While, the Sensitivity and specificity of RAPS in this regard were 61.39% (95%CI: 53.33% - 69.02%) and 71.12% (95%CI: 67.94% - 74.16%), respectively. The area under the receiver operating characteristic (ROC) curve of REMS and RAPS were 0.72 (95% CI: 0.68 -0.75) and 0.62 (95% CI: 0.56 - 0.65) in predicting the patients' 28-day mortality, respectively (p = 0.001). Conclusion The total accuracies of REMS and RAPS in predicting the 28-day mortality of non-trauma patients were in good and poor range, respectively. The screening performance characteristics of REMS were a little better in this regard.
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Affiliation(s)
- Omid Garkaz
- School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Farzin Rezazadeh
- Emergency Medicine Department, Urmia University of Medical Sciences, Urmia, Iran
| | - Saeed Golfiroozi
- Department of Emergency Medicine, School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Sahar Paryab
- School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Sadaf Nasiri
- Urmia University of Medical Sciences, Urmia, Iran
| | - Hamidreza Mehryar
- Department of Emergency Medicine, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran.,Corresponding author: Hamidreza Mehryar; Resalat Boulevard, Emergency Alley, Urmia, Iran. Postal address: 5714783734,
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Khari S, Zandi M, Yousefifard M. Glasgow Coma Scale Versus Physiologic Scoring Systems in Predicting the Outcome of ICU admitted Trauma Patients; a Diagnostic Accuracy Study. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2022; 10:e25. [PMID: 35573721 PMCID: PMC9078058 DOI: 10.22037/aaem.v10i1.1483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction There is no consensus on the performance of decision rules in predicting the prognosis of trauma patients. Therefore, the present study aimed to compare the value of Glasgow coma scale (GCS) and physiologic scoring systems in predicting mortality and poor outcome of trauma patients. Methods This diagnostic accuracy study was conducted on multiple trauma patients admitted to the intensive care units of two hospitals in Tehran, Iran, from 21 November 2020 to 22 May 2021. The patients' demographic characteristics, length of stay in the intensive care unit (ICU), the vital signs, and the GCS on admission were recorded. Finally, the mortality, disability, and complete recovery of patients at the time of discharge were evaluated and receiver operating characteristics (ROC) curve analysis was used to compare the performance of physiologic scoring systems with GCS. Results 200 trauma patients with the mean age of 43.53±19.84 years were evaluated (74% male). The area under the ROC curve for New Trauma Score (NTS), Revised Trauma Score (RTS), Worthing Physiological Scoring System (WPSS), Rapid Acute Physiology Score (RAPS), Rapid Emergency Medicine Score (REMS), Modified Early Warning Score (MEWS), National Early Warning Score (NEWS), Glasgow Coma Scale, Age, and Systolic Blood Pressure score (GAPS) ,Glasgow coma scale (GCS) in prediction of mortality were 0.95, 0.95, 0.83, 0.89, 0.91, 0.84, 0.77, 0.97, and 0.98 respectively. The performance of GCS was statistically superior to RTS (P=0.005), WPSS (P=0.0001), RAPS (P=0.0002), REMS (P=0.002), MEWS (P<0.0001), and NEWS (P<0.0001). However, the performance of GCS, NTS (P=0.146), and GAPS (P=0.513) were not significantly different. Also, in prediction of poor outcomes, the AUC of GCS (0.98) was significantly higher than RTS (0.95), RAPS (0.85), REMS (0.85), MEWS (0.84), NEWS (0.77), and WPSS (0.75). Conclusion The GCS score seems to be a better instrument to predict mortality and poor outcome in trauma patients compared to other tools due to its high accuracy, wide application, and easy calculation.
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Affiliation(s)
- Sorour Khari
- Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mitra Zandi
- School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahmoud Yousefifard
- Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran
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Yazdanbakhsh M, Saghaei Dehkordi S. An Overview of Published Articles in Archives of Academic Emergency Medicine in 2021. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2022; 10:e18. [PMID: 35402996 PMCID: PMC8986493 DOI: 10.22037/aaem.v10i1.1555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Mehrnoosh Yazdanbakhsh
- Journal Office, Emergency Ward, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Somayeh Saghaei Dehkordi
- Journal Office, Emergency Ward, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Corresponding author: Somayeh Saghaei Dehkordi; Emergency Ward, Shohadaye Tajrish Hospital, Shahrdari Avenue, Tajrish Square, Tehran, Iran. Tel: 00989388136564
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