Olsson Thomas, Lind Lars
Department of Internal Medicine, University of Uppsala, Uppsala, Sweden.
Acad Emerg Med. 2003 Oct;10(10):1040-8. doi: 10.1111/j.1553-2712.2003.tb00572.x.
To improve the Rapid Acute Physiology Score (RAPS) as a predictor of in-hospital mortality in the nonsurgical emergency department (ED) by including age and oxygen saturation, and to compare this new system, Rapid Emergency Medicine Score (REMS), with the Acute Physiology and Chronic Health Examination (APACHE II) with reference to predictive accuracy.
This was a prospective cohort study. One hundred sixty-two critically ill patients consecutively admitted to the intensive care unit (ICU) during the period of one year, and 865 nonsurgical patients presenting to an adult emergency department (ED) and admitted to a medical department of a 1200-bed university hospital during two months, were enrolled. For all entries to the ED, RAPS was calculated and developed to include noninvasive peripheral oxygen saturation and patient age (REMS), as well as laboratory tests (APACHE II). These scores were calculated for each patient.
REMS was found to be superior to RAPS in predicting in-hospital mortality both in the critically ill patients admitted to the ICU and in the total sample (area under receiver-operating characteristic curve [AUC] 0.910 +/- 0.015 for REMS compared with 0.872 +/- 0.022 for RAPS, p < 0.001). An increase of 1 point in the 26-point REMS scale was associated with an odds ratio of 1.40 for in-hospital death (95% confidence interval = 1.36 to 1.45, p < 0.0001). The more advanced APACHE II was not found to be superior to REMS (AUC: 0.901 +/- 0.015, p = 0.218).
RAPS could be improved as a predictor of in-hospital mortality in the nonsurgical ED by including oxygen saturation and patient age to the system. This new scoring system, REMS, had the same predictive accuracy as the well-established, but more complicated, APACHE II.
通过纳入年龄和血氧饱和度来改进快速急性生理学评分（RAPS），使其成为非手术急诊科（ED）住院死亡率的预测指标，并将这个新系统——快速急诊医学评分（REMS）与急性生理学与慢性健康状况评估系统（APACHE II）在预测准确性方面进行比较。
这是一项前瞻性队列研究。连续入选了162例在一年期间入住重症监护病房（ICU）的危重症患者，以及865例在两个月内就诊于一所拥有1200张床位的大学医院成人急诊科（ED）并入住内科的非手术患者。对于所有进入急诊科的患者，计算RAPS并进行改进，使其纳入无创外周血氧饱和度和患者年龄（REMS）以及实验室检查结果（APACHE II）。为每位患者计算这些评分。
在预测入住ICU的危重症患者以及总体样本的住院死亡率方面，REMS被发现优于RAPS（REMS的受试者操作特征曲线下面积[AUC]为0.910±0.015，而RAPS为0.872±0.022，p<0.001）。26分的REMS量表每增加1分，住院死亡的比值比为1.40（95%置信区间=1.36至1.45，p<0.0001）。未发现更先进的APACHE II优于REMS（AUC：0.901±0.015，p=0.218）。
通过将血氧饱和度和患者年龄纳入系统，RAPS可作为非手术急诊科住院死亡率的预测指标得到改进。这个新的评分系统REMS与成熟但更复杂的APACHE II具有相同的预测准确性。
