Toloui Amirmohammad, Madani Neishaboori Arian, Rafiei Alavi Seyedeh Niloufar, Gubari Mohammed I M, Zareie Shab Khaneh Amirali, Karimi Ghahfarokhi Maryam, Amraei Fatemeh, Behroozi Zahra, Hosseini Mostafa, Ahmadi Sajjad, Yousefifard Mahmoud
Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran.
First and second authors have contributed equally.
Arch Acad Emerg Med. 2021 Sep 9;9(1):e60. doi: 10.22037/aaem.v9i1.1274. eCollection 2021.
There is no comprehensive meta-analysis on the value of physiological scoring systems in predicting the mortality of critically ill patients. Therefore, the present study intended to conduct a systematic review and meta-analysis to collect the available clinical evidence on the value of physiological scoring systems in predicting the in-hospital mortality of acute patients.
An extensive search was performed on Medline, Embase, Scopus, and Web of Science databases until the end of year 2020. Physiological models included Rapid Acute Physiology Score (RAPS), Rapid Emergency Medicine Score (REMS), modified REMS (mREMS), and Worthing Physiological Score (WPS). Finally, the data were summarized and the findings were presented as summary receiver operating characteristics (SROC), sensitivity, specificity and diagnostic odds ratio (DOR).
Data from 25 articles were included. The overall analysis showed that the area under the SROC curve of REMS, RAPS, mREMS, and WPS criteria were 0.83 (95% CI: 0.79-0.86), 0.89 (95% CI: 0.86-0.92), 0.64 (95% CI: 0.60-0.68) and 0.86 (95% CI: 0.83-0.89), respectively. DOR for REMS, RAPS, mREMS and WPS models were 11 (95% CI: 8-16), 13 (95% CI: 4-41), 2 (95% CI: 2-4) and 17 (95% CI: 5-59) respectively. When analyses were limited to trauma patients, the DOR of the REMS and RAPS models were 112 and 431, respectively. Due to the lack of sufficient studies, it was not possible to limit the analyses for mREMS and WPS.
The findings of the present study showed that three models of RAPS, REMS and WPS have a high predictive value for in-hospital mortality. In addition, the value of these models in trauma patients is much higher than other patient settings.
目前尚无关于生理评分系统在预测危重症患者死亡率方面价值的全面荟萃分析。因此，本研究旨在进行系统评价和荟萃分析，以收集有关生理评分系统在预测急性患者院内死亡率方面价值的现有临床证据。
截至2020年底，对Medline、Embase、Scopus和Web of Science数据库进行了广泛检索。生理模型包括快速急性生理学评分（RAPS）、快速急诊医学评分（REMS）、改良REMS（mREMS）和沃辛生理评分（WPS）。最后，对数据进行汇总，并将结果以汇总受试者工作特征（SROC）、敏感性、特异性和诊断比值比（DOR）的形式呈现。
纳入了25篇文章的数据。总体分析表明，REMS、RAPS、mREMS和WPS标准的SROC曲线下面积分别为0.83（95%CI：0.79 - 0.86）、0.89（95%CI：0.86 - 0.92）、0.64（95%CI：0.60 - 0.68）和0.86（95%CI：0.83 - 0.89）。REMS、RAPS、mREMS和WPS模型的DOR分别为11（95%CI：8 - 16）、13（95%CI：4 - 41）、2（95%CI：2 - 4）和17（95%CI：5 - 59）。当分析仅限于创伤患者时，REMS和RAPS模型的DOR分别为112和431。由于缺乏足够的研究，无法对mREMS和WPS进行限定分析。
本研究结果表明，RAPS、REMS和WPS这三种模型对院内死亡率具有较高的预测价值。此外，这些模型在创伤患者中的价值远高于其他患者群体。
