Comparison of the rapid emercency medicine score and modified early warning score in prediction of 28-days mortality of 65 years and older patients who admitted emergency department

Introduction: We aimed to compare the safety and efficacy of Rapid Emergency Medicine Score (REMS), Rapid Emergency Medicine Score-Lactate (REMS-L), Modified Early Warning Score (MEWS) and Modified Early Warning Score-Lactate (MEWS-L) scores which used in predicting mortality in patients presented to emergency department aged 65 years and older to investigate their usefulness in 28-day mortality prediction. Material-Methods: The study was carried out between February 29, 2016 - April 30, 2016 at the Atatürk Educational Research Hospital Emergency Service. Prospective observational study included patients aged 65 years and older who were referred to emergency services as red and yellow and who did not have a trauma story. The patients were then assessed by an emergency medical assistant or specialist in charge of the relevant area. The patient's anamnesis and resume were recorded and their vital signs were checked. Blood gas was taken at the first visit to the patients within the indication. REMS, REMS-L, MEWS and MEWS-L scores were calculated and recorded in the study form by the data obtained by the clinician. REMS-L calculation formula: REMS + lactate (mmol / L). MEWS-L calculation formula: MEWS + lactate (mmol / L). The telephone numbers of the patients taken to study were also recorded. Patients admitted to the hospital were followed up through the system and mortality was investigated within 28 days. At the end of the 28th day, the patient was discharged on the phone numbers and the situation was learned. Patients who could not be reached at the end of this period were excluded from the study. Results: The mean age of 1106 patients included in the study was calculated as 77.23 ± 7.41 years and the median value was 77 years. 52,3% (n = 578) of the patients were female and 47,7% (n = 528) were male. In the prediction of hospital admission, the area under the ROC curve for REMS, REMS-L, MEWS and MEWS-L were 0,837; 0,918; 0,817; 0,927 respectively; ; (with p value order, p = 0,001; p <0,001; p = 0;002; p <0,001). The 28-day mortality below the ROC curve for REMS, REMS-L, MEWS and MEWS-L were 0,659; 0,695; 0,647; 0,681 respectively,; (with p value order, p <0,001; p <0,001; p <0,001; p<0,001). Conclusion: REMS and MEWS are easy to use and strong scoring scores for geriatric patient hospitalization and 28-day mortality prediction. REMS was found to be more effective than MEWS in predicting hospitalization and mortality. The combination of REMS and MEWS with lactate may increase the 28-day mortality prediction in geriatric patients.