title: The comparison of modified early warning score with rapid emergency medicine score: a prospective multicentre observational cohort study on medical and surgical patients presenting to emergency department.
abstract: OBJECTIVE
  There are a few scoring systems in emergency departments (ED) to establish critically ill patients quickly and properly and to predict hospitalisation. We aim to compare the efficacy of Modified Early Warning Score (MEWS) and Rapid Emergency Medicine Score (REMS) on in-hospital mortality, and as predictor of hospitalisation in general medical and surgical patients admitted to ED.
  
  
  METHODS
  This is a prospective, multicentre and observational cohort study. The study included general medical and surgical patients admitted to the EDs of three education and research hospitals during a period of 6 months. The primary outcome of the study is the admission of the patient to a ward/an intensive care unit (ICU)/high dependency unit (HDU) and in-hospital mortality. Receiver operating characteristics (ROC) curve analysis was performed to evaluate and compare the performances of two scores.
  
  
  RESULTS
  Total patients were 2000 (51.95% male, 48.05% female). The mean age was 61.41±18.92. Median MEWS and REMS values of the patients admitted to the ICU/HDU from ED were 1 and 6, respectively; and there was a significant difference in terms of REMS values, compared with patients discharged from ED. REMS (area under the curve (AUC): 0.642) was found to have a better predictive strength than MEWS (AUC: 0.568) in discriminating in-patients and discharged patients. Additionally, REMS (0.707) was superior to MEWS (AUC 0.630) in terms of predicting in-hospital mortality of patients presenting to ED.
  
  
  CONCLUSIONS
  The efficiency of REMS was found to be superior to MEWS as a predictor of in-hospital mortality and hospitalisation in medical and surgical patients admitted to ED.
authors.affiliation: Department of Emergency Medicine, Bursa Sevket Yılmaz Education and Research Hospital, Bursa, Turkey.
authors.forename: Mehtap
authors.initials: M
authors.lastname: Bulut
authors.affiliation: Department of Emergency Medicine, Kayseri Education and Research Hospital, Kayseri, Turkey.
authors.forename: Huseyin
authors.initials: H
authors.lastname: Cebicci
authors.affiliation: Department of Biostatistic., Uludag University Faculty of Medicine, Bursa, Turkey.
authors.forename: Deniz
authors.initials: D
authors.lastname: Sigirli
authors.affiliation: Department of Emergency Medicine, Bursa Sevket Yılmaz Education and Research Hospital, Bursa, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Sak
authors.affiliation: Department of Emergency Medicine, İstanbul Umraniye Education and Research Hospital, İstanbul, Turkey.
authors.forename: Oya
authors.initials: O
authors.lastname: Durmus
authors.affiliation: Department of Emergency Medicine, Trabzon Numune Education and Research Hospital, Trabzon, Turkey.
authors.forename: Ahmet Ali
authors.initials: AA
authors.lastname: Top
authors.affiliation: Department of Emergency Medicine, Bursa Sevket Yılmaz Education and Research Hospital, Bursa, Turkey.
authors.forename: Sinan
authors.initials: S
authors.lastname: Kaya
authors.affiliation: Department of Emergency Medicine, Bursa Sevket Yılmaz Education and Research Hospital, Bursa, Turkey.
authors.forename: Kamil
authors.initials: K
authors.lastname: Uz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness / Q000401:mortality; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006305:Health Status Indicators; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D012720:Severity of Illness Index; D014421:Turkey / Q000453:epidemiology
keywords: death/mortality; emergency care systems, emergency departments; management, risk management