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. 2021 Jun 29;2(4):e12483.
doi: 10.1002/emp2.12483. eCollection 2021 Aug.

Initial prehospital Rapid Emergency Medicine Score (REMS) to predict outcomes for COVID-19 patients

Scott S Bourn  1 , Remle P Crowe  1 , Antonio R Fernandez  1   2 , Sarah E Matt  1 , Andrew L Brown  1 , Andrew B Hawthorn  1 , J Brent Myers  1
Affiliations

Initial prehospital Rapid Emergency Medicine Score (REMS) to predict outcomes for COVID-19 patients

Scott S Bourn et al. J Am Coll Emerg Physicians Open. .

Abstract

Objective: The Rapid Emergency Medicine Score (REMS) has not been widely studied for use in predicting outcomes of COVID-19 patients encountered in the prehospital setting. This study aimed to determine whether the first prehospital REMS could predict emergency department and hospital dispositions for COVID-19 patients transported by emergency medical services.

Methods: This retrospective study used linked prehospital and hospital records from the ESO Data Collaborative for all 911-initiated transports of patients with hospital COVID-19 diagnoses from July 1 to December 31, 2020. We calculated REMS with the first recorded prehospital values for each component. We calculated area under the receiver operating curve (AUROC) for emergency department (ED) mortality, ED discharge, hospital mortality, and hospital length of stay (LOS). We determined optimal REMS cut-points using test characteristic curves.

Results: Among 13,830 included COVID-19 patients, median REMS was 6 (interquartile range [IQR]: 5-9). ED mortality was <1% (n = 80). REMS ≥9 predicted ED death (AUROC 0.79). One-quarter of patients (n = 3,419) were discharged from the ED with an optimal REMS cut-point of ≤5 (AUROC 0.72). Eighteen percent (n = 1,742) of admitted patients died. REMS ≥8 optimally predicted hospital mortality (AUROC 0.72). Median hospital LOS was 8.3 days (IQR: 4.1-14.8 days). REMS ≥7 predicted hospitalizations ≥3 days (AUROC 0.62).

Conclusion: Initial prehospital REMS was modestly predictive of ED and hospital dispositions for patients with COVID-19. Prediction was stronger for outcomes more proximate to the first set of emergency medical services (EMS) vital signs. These findings highlight the potential value of first prehospital REMS for risk stratification of individual patients and system surveillance for resource planning related to COVID-19.

Keywords: COVID‐19; Emergency Medical Services; Patient Outcomes; Prehospital; Retrospective Studies; Risk Stratification; Scoring System; Triage.

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Conflict of interest statement

The authors have no conflicts of interest to report.

Figures

FIGURE 1
FIGURE 1
Inclusion of EMS patient care records for analysis. Abbreviations: EMS, emergency medical services; REMS, Rapid Emergency Medicine Score
FIGURE 2
FIGURE 2
ED and hospital dispositions of analysis sample. Abbreviations: ED, emergency department; REMS, Rapid Emergency Medicine Score. First prehospital REMS are presented as medians and interquartile ranges. Outcome 1: ED Mortality = ED death [A] versus No ED Death [B+C+D+E] Outcome 2: ED Discharge = ED Discharge [B] versus Admitted/Transferred/Hospice [C+D+E] Outcome 3: Hospital Mortality = Hospital Death [F] versus Hospital Discharge [G]
FIGURE 3
FIGURE 3
Hospital length of stay among emergency medical services patients with COVID‐19
See this image and copyright information in PMC

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