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Observational Study
. 2021 Nov:49:259-264.
doi: 10.1016/j.ajem.2021.06.020. Epub 2021 Jun 10.

Effectiveness of the rapid emergency medicine score and the rapid acute physiology score in prognosticating mortality in patients presenting to the emergency department with COVID-19 symptoms

Serdar Özdemir  1 , Hatice Şeyma Akça  2 , Abdullah Algın  2 , İbrahim Altunok  2 , Serkan Emre Eroğlu  2
Affiliations
Observational Study

Effectiveness of the rapid emergency medicine score and the rapid acute physiology score in prognosticating mortality in patients presenting to the emergency department with COVID-19 symptoms

Serdar Özdemir et al. Am J Emerg Med. 2021 Nov.

Abstract

Objective: We investigated the effectiveness of the Rapid Emergency Medicine Score and the Rapid Acute Physiology Score in identifying critical patients among those presenting to the emergency department with COVID-19 symptoms.

Material and methods: This prospective, observational, cohort study included patients with COVID-19 symptoms presenting to the emergency department over a two-month period. Demographics, clinical characteristics, and the data of all-cause mortality within 30 days after admission were noted, and the Rapid Emergency Medicine Score and the Rapid Acute Physiology Score were calculated by the researchers. The receiver operating characteristic curve analysis was performed to determine the discriminative ability of the scores.

Results: A total of 555 patients with a mean of age of 49.4 ± 16.8 years were included in the study. The rate of 30-day mortality was 3.9% for the whole study cohort, 7.2% for the patients with a positive rt-PCR test result for SARS-CoV-2, and 1.2% for those with a negative rt-PCR test result for SARS-CoV-2. In the group of patients with COVID-19 symptoms, according to the best Youden's index, the cut-off value for the Rapid Emergency Medicine Score was determined as 3.5 (sensitivity: 81.82%, specificity: 73.08%), and the area under curve (AUC) value was 0.840 (95% confidence interval 0.768-0.913). In the same group, according to the best Youden's index, the cut-off value for the Rapid Acute Physiology Score was 2.5 (sensitivity: 90.9%, specificity: 97.38%), and the AUC value was 0.519 (95% confidence interval 0.393-0.646).

Conclusion: REMS is able to predict patients with COVID-19-like symptoms without positive rt-PCR for SARS-CoV-2 that are at a high-risk of 30-day mortality. Prospective multicenter cohort studies are needed to provide best scoring system for triage in pandemic clinics.

Keywords: COVID-19; Coronavirus infections; Early warning scores; Rapid acute physiology score; Rapid emergency medicine score; Triage.

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Conflict of interest statement

Declaration of Competing Interest We declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Flow chart of the study.
Fig. 2
Fig. 2
Receiver operating characteristic curves for the Rapid Emergency Medicine Score (REMS) and the Rapid Acute Physiology Score (RAPS) for the prediction of 30-day mortality in all patients presenting with COVID-19 symptoms.
Fig. 3
Fig. 3
Receiver operating characteristic curves for the Rapid Emergency Medicine Score (REMS) and the Rapid Acute Physiology Score (RAPS) for the prediction of 30-day mortality in patients with a positive rt-PCR test for SARS-CoV-2 (a) and those with a negative rt-PCR test for SARS-CoV-2 (b).
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