REMS v.1
Rapid emergency medicine score (REMS) predicting in-hospital mortality in nonsurgical adult patients presenting to the ED.
To record Rapid emergency medicine score (REMS) and subscores, predicting in-hospital mortality in nonsurgical adult patients presenting to the ED. Calculated with values obtained out of hospital, or in hospital without lab studies. Helps guide aggressiveness of treatment with parameters routinely acquired in the prehospital setting.
Use for critically ill patients, where in-hospital mortality prediction may help guide treatment modalities. May not add to clinician gestalt, but can be useful in the prehospital setting for determining whether a patient would benefit from rapid access to advanced life support services. REMS is superior (Olsson 2004) to the Rapid Acute Physiology Score (RAPS) (Rhee 1987) and non-inferior to APACHE II (Olsson 2003). REMS is calculated as the addition of the selected points: Variable Conditon Points Age, years <45 0 45-54 2 55-64 3 65-74 5 >74 6 Mean arterial pressure, mmHg >159 4 130-159 3 110-129 2 70-109 0 50-69 2 ≤49 4 Heart rate, beats per minute >179 4 140-179 3 110-139 2 70-109 0 55-69 2 40-54 3 ≤39 4 Respiratory rate, per minute >49 4 35-49 3 25-34 1 12-24 0 10-11 1 6-9 2 ≤5 4 Peripheral oxygen saturation <75% 4 75-85% 3 86-89% 1 >89% 0 Glasgow Coma Scale <5 4 5-7 3 8-10 2 11-13 1 >13 0 High risk (REMS ≥3): patient may need aggressive treatment. Low risk (REMS <3): patient may be appropriate to triage for routine treatment (in Olsson 2004, all patients with REMS <3 survived). Interpretation: REMS In-hospital mortality 0-2 0% 3-5 1% 6-9 3% 10-11 4% 12-13 10% 14-15 17% 16-17 38% 18-19 75% 20-21 56%* 22-23 66%* 24-26 100% *Note that <0.3% of patients had scores >19, which may account for the paradoxical apparent decrease in events between scores of 19 and scores >19.
Mortality rapidly increases above a score of 10. Consider more aggressive treatment in patients with higher scores (in conjunction with patient wishes and clinical judgment). Clinical judgment of a patient’s presentation should always be used to determine need for advanced interventions. Not validated for pediatric patients.
[1] Olsson T, Terent A, Lind L. Rapid Emergency Medicine score: a new prognostic tool for in-hospital mortality in nonsurgical emergency department patients. J Intern Med. 2004;255(5):579-87. [2] Rhee KJ, Fisher CJ, Willitis NH. The Rapid Acute Physiology Score. Am J Emerg Med. 1987;5(4):278-82. [3] Olsson T, Lind L. Comparison of the rapid emergency medicine score and APACHE II in nonsurgical emergency department patients. Acad Emerg Med. 2003;10(10):1040-8. [4] Imhoff BF, Thompson NJ, Hastings MA, et al. Rapid Emergency Medicine Score (REMS) in the trauma population: a retrospective study. BMJ Open 2014;4:e004738.
OBSERVATION.pulse.v2, OBSERVATION.blood_pressure.v2, OBSERVATION.respiration.v2, OBSERVATION.basic_demographic.v1, OBSERVATION.glasgow_coma_scale.v1, OBSERVATION.rems.v0, OBSERVATION.lab_test-blood_gases.v1, EVALUATION.rems_assessment.v0
