The Modified Rapid Emergency Medicine Score: A Novel Trauma Triaging Tool for Predicting In-hospital Mortality

Abstract

Objectives: Trauma systems currently rely on imperfect and subjective tools to prioritize responses and resources, thus there is a critical need to develop a more accurate trauma severity score. Our objective was to modify the Rapid Emergency Medicine Score (REMS is a simple, non-invasive, and objective version of the APACHE II score) for the trauma population and test its accuracy as a predictor of in-hospital mortality when compared to other currently used scores, including the Revised Trauma Score (RTS), the Injury Severity Score (ISS), the “Mechanism, Glasgow Coma Scale, Age and Arterial Pressure” (MGAP) score, and the Shock Index (SI) score. Methods: This was a two-part study design. The first part incorporated a retrospective analysis of a local trauma database (3,680 patients) where three components of REMS were modified to more accurately represent the trauma population. Using clinical judgment and goodness of fit tests, systolic blood pressure was substituted for mean arterial pressure, the weighting of age was reduced, and the weighting of GCS was increased. The second part comprised of validating the new mREMS score retrospectively on a U.S. national trauma database that included 429,711 patients admitted with trauma over a 1-year period. The discriminate power of modified REMS (mREMS) was compared to other trauma scores using the area under the receiver operating characteristic (ROC) curve. Results: The mREMS score (AUC 0.97) was demonstrated to be higher than RTS (AUC 0.96), ISS (AUC 0.78), MGAP (AUC 0.96), and SI (AUC 0.67) in predicting in-hospital mortality. Discussion: In the trauma population, mREMS is an accurate predictor of in-hospital mortality, outperforming other used scores. Simple and objective, mREMS may hold value in the pre-hospital and emergency department setting in order to guide trauma team responses.