title: Prognostic performance of the Rapid Emergency Medicine Score (REMS) and Worthing Physiological Scoring system (WPS) in emergency department.
abstract: BACKGROUND
  The Rapid Emergency Medicine Score (REMS) and Worthing Physiological Scoring system (WPS) have been developed for predicting in-hospital mortality in nonsurgical emergency department (ED) patients. The prognostic performance of the scoring systems in independent populations has not been clear. The aim of the study is to evaluate the prognostic accuracy of REMS and WPS systems in the estimation of 30-day mortality risk among medical patients in ED.
  
  
  METHODS
  The study was designed as a prospective investigation, with the setting being the ED of the National Hospital of Can Tho, Vietnam. We enrolled medical patients aged 16+ years who met the study entry criteria. Clinical data were obtained as required for each scoring system. The primary outcome was mortality within 30 days since hospitalization. The association between each scoring system and mortality was assessed by the hazard ratio (HR) of the Cox's proportional hazard model.
  
  
  RESULTS
  The study involved 1746 patients, average age 65.9 years (SD 17). During the period of follow-up, 172 patients (9.9 %) died. The risk of 30-day mortality was increased by 30 % for each additional REMS unit (HR: 1.28; 95 % confidence interval (CI): 1.23-1.34) and by 60 % for each additional WPS unit (HR: 1.6; 95 % CI: 1.5-1.7). The AUC of the REMS was 0.71 (95 % CI: 0.67-0.76) which was significantly lower than that of the WPS (0.80; 95 % CI: 0.76-0.83).
  
  
  CONCLUSIONS
  Both REMS and WPS have good prognostic value in the prediction of death in ED patients. The WPS appeared to have a better prognostic performance than the REMS system.
authors.affiliation: Intensive Care Unit, National Hospital of Can Tho, Can Tho City, Vietnam ; Ton Duc Thang University, Ho Chi Minh City, Vietnam.
authors.forename: Duc T
authors.initials: DT
authors.lastname: Ha
authors.affiliation: Intensive Care Unit, National Hospital of Can Tho, Can Tho City, Vietnam.
authors.forename: Tam Q
authors.initials: TQ
authors.lastname: Dang
authors.affiliation: Department of Internal Medicine, University of Medicine and Pharmacy in Ho Chi Minh City, Ho Chi Minh City, Vietnam.
authors.forename: Ngoc V
authors.initials: NV
authors.lastname: Tran
authors.affiliation: Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam.
authors.forename: Nhi Y
authors.initials: NY
authors.lastname: Vo
authors.affiliation: Ton Duc Thang University, Ho Chi Minh City, Vietnam.
authors.forename: Nguyen D
authors.initials: ND
authors.lastname: Nguyen
authors.affiliation: Ton Duc Thang University, Ho Chi Minh City, Vietnam ; Garvan Institute of Medical Research, Sydney, Australia ; School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia ; Centre for Health Technologies, University of Technology, Sydney, Australia.
authors.forename: Tuan V
authors.initials: TV
authors.lastname: Nguyen
keywords: Emergency department; Prognostic model; Rapid emergency medicine score; Worthing physiological scoring system