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Published on: January 30, 2018
Performance of the Modified Rapid Emergency Medicine Score in Patients With and Without Traumatic Brain Injury
Abstract:
BACKGROUND: The modified Rapid Emergency Medicine Score (mREMS) is a recently published index to estimate the severity of trauma patients; however, little is known about its performance in patients with different types of trauma. This study verified the predictive capacity of mREMS in-hospital mortality in patients of blunt and penetrating trauma with and without traumatic brain injury (TBI) and the performance of this index compared with the Rapid Emergency Medicine Score, Injury Severity Score, New Injury Severity Score, and Trauma and Injury Severity Score. METHODS: This is a retrospective, correlational study that analyzed trauma patients 18 years or older, who attended at a hospital in Rio de Janeiro, Brazil. The receiver operating characteristic (ROC) curve was applied in the analyses. RESULTS: The sample consisted of 987 patients, 359 (36.4%) with TBI (225 blunt and 134 penetrating trauma). Regarding mREMS, the area under the ROC curve for TBI patients for in-hospital mortality was 0.506 (95% confidence interval [CI], 0.404-0.609) for penetrating injuries and 0.486 (95% CI, 0.402-0.571) for blunt injuries; the values in patients without TBI were 0.629 (95% CI, 0.554-0.703) and 0.618 (95% CI, 0.552-0.684), respectively. In relation to the other indices the mREMS presented the lowest area under the curve/ROC for penetrating and blunt TBI, and the Rapid Emergency Medicine Score for extracranial injuries. CONCLUSION: The mREMS showed no prognostic capacity for patients with TBI, and it presented the worst performance in relation to the Injury Severity Score, New Injury Severity Score, and Trauma and Injury Severity Score to discriminate cases of in-hospital mortality when considering trauma patients with and without TBI.
Insights
The modified Rapid Emergency Medicine Score (mREMS) did not predict in-hospital mortality in trauma patients with traumatic brain injury (TBI). mREMS performed poorly compared to other trauma scores in predicting mortality for TBI and non-TBI patients.
Area of Science:
- Trauma Care
- Emergency Medicine
- Clinical Prediction Models
Background:
- The modified Rapid Emergency Medicine Score (mREMS) is a new index for assessing trauma patient severity.
- Its predictive performance across different trauma types, including blunt and penetrating injuries with or without traumatic brain injury (TBI), is not well-established.
Purpose of the Study:
- To evaluate the predictive capacity of mREMS for in-hospital mortality in trauma patients.
- To compare mREMS performance against established scores like the Rapid Emergency Medicine Score (REMS), Injury Severity Score (ISS), New Injury Severity Score (NISS), and Trauma and Injury Severity Score (TRISS).
Main Methods:
- Retrospective correlational study of 987 trauma patients aged 18+ in Rio de Janeiro, Brazil.
- Analysis of in-hospital mortality prediction using receiver operating characteristic (ROC) curves.
- Comparison of mREMS with REMS, ISS, NISS, and TRISS.
Main Results:
- mREMS showed poor predictive capacity for in-hospital mortality in TBI patients (Area Under Curve [AUC] for penetrating TBI: 0.506; blunt TBI: 0.486).
- mREMS also demonstrated limited predictive ability in non-TBI patients (AUC for penetrating: 0.629; blunt: 0.618).
- mREMS exhibited the lowest AUC for TBI patients and REMS for extracranial injuries compared to other scores.
Conclusions:
- The mREMS demonstrated no significant prognostic capacity for in-hospital mortality in trauma patients with TBI.
- mREMS showed inferior performance in discriminating mortality compared to ISS, NISS, and TRISS across trauma patient groups.
