4.6 Article

Modified Rapid Emergency Medicine Score-Lactate (mREMS-L) performance to screen non-anticipated 30-day-related-mortality in emergency department

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WILEY
DOI: 10.1111/eci.13994

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early death; emergency department; lactate; modified Rapid Emergency Medicine Score; mREMS-L

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This study compared the predictive ability of lactate, modified Rapid Emergency Medicine Score (mREMS), and mREMS plus lactate (mREMS-L) for 30-day in-hospital mortality. The results showed that mREMS-L had better predictive ability than mREMS and lactate separately.
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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