Comparison of the Eastern Cooperative Oncology Group Scale (ECOG) to Rapid Emergency Medicine Score (REMS) for early period of prognosis prediction in cancer patients who have presented to the ER with any complaint or etiology.

Introduction: Increasing awareness of society about cancer and developing new technologies provide early diagnosis and new therapeutic approaches make cancer patients to survive longer. They all cause a longer following up period of the patients and more applications to the emergency room (ER).Purpose: We have compared the Eastern Cooperative Oncology Group Scale (ECOG) to Rapid Emergency Medicine Score (REMS) for early period of prognosis prediction in patients who have presented to the ER with any complaint or etiology.Material and Method: This prospective observational clinical study has been carried out between 15/01/2010 to 15/07/2010 in Gazi University, Faculty of Medicine, Department of Emergency Medicine where 48 000 adult patients get secondary or tertiary care in a year.Results: Of 598 (2.08%) cancer presentations have been taken in the study. All of the 598 presentations, 347 (76.9%) was only one time and 324 (57.2%) of the total number was man. Mean age was 59.11±15.58. Shortness of breath was the most common complaint (n=149, 25%). There was a documented metastasis in 267 cases (44.6%). Five patients (0.84%) have been diagnosed as cancer first time in the ER. Of 327 (54.2%) were discharged from but 27 (4.5%) patients died in ER. Those who died in the emergency department, 12 of them (44%) died within the first 24 hours. ECOG score was 4 in 243 presentations (40.6%). REMS score was 5 in 114 (19.1%) presentations. Among them whose REMS score was 5 died in the ER within the first 24 hours. Among all of the dead patients, the highest mean average ECOG score was in patients who died between 24 hours to 7 th day and the highest mean average REMS score was in patients who died in the first 24 hours. All patients who died at the day 30th, ECOG and REMS scores revealed positive weak and statistically significant correlation (Superman?s rho: p<0.001, r=0.2663 and p<0.001, r=0.286).Conclusion: REMS score was superior to the ECOG score in prediction of mortality within the first 24 hours (0,779, p<0.001). The two scoring system revelaed no statistically significant difference in mortality rates between 24th hour to 7th day or 7th day to 30th day.