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

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, emergen...

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Bibliographic Details
Published in:European journal of clinical investigation 2023-08, Vol.53 (8), p.e13994-n/a
Main Authors: Donoso Calero, M Isabel, Laura Mordillo‐Mateos, José L Martín‐Conty, Begoña Polonio‐López, Ángel López‐González, Carlos Durantez‐Fernández, Viñuela, Antonio, Marta Rodríguez Hernández, Alicia Mohedano‐Moriano, Raúl López‐Izquierdo, Soto, Cristina Jorge, Francisco Martín‐Rodríguez
Format: Article
Language:English
Subjects:
early death
emergency department
Emergency medical care
Emergency medical services
Emergency vehicles
Hospitals
lactate
Lactic acid
Mathematical analysis
modified Rapid Emergency Medicine Score
Mortality
mREMS‐L
Sensitivity
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Summary: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 
ISSN:0014-2972
1365-2362
DOI:10.1111/eci.13994