title: Rapid Acute Physiology Score versus Rapid Emergency Medicine Score in Trauma Outcome Prediction; a Comparative Study.
abstract: BACKGROUND
  Rapid acute physiology score (RAPS) and rapid emergency medicine score (REMS) are two physiologic models for measuring injury severity in emergency settings. The present study was designed to compare the two models in outcome prediction of trauma patients presenting to emergency department (ED).
  
  
  METHODS
  In this prospective cross-sectional study, the two models of RAPS and REMS were compared regarding prediction of mortality and poor outcome (severe disability based on Glasgow outcome scale) of trauma patients presenting to the EDs of 5 educational hospitals in Iran (Tehran, Tabriz, Urmia, Jahrom and Ilam) from May to October 2016. The discriminatory power and calibration of the models were calculated and compared using STATA 11.
  
  
  RESULTS
  2148 patients with the mean age of 39.50±17.27 years were studied (75.56% males). The area under the curve of REMS and RAPS in predicting in-hospital mortality were calculated to be 0.93 (95% CI: 0.92-0.95) and 0.899 (95% CI: 0.86-0.93), respectively (p=0.02). These measures were 0.92 (95% CI: 0.90-0.94) and 0.86 (95% CI: 0.83-0.90), respectively, regarding poor outcome (p=0.001). The optimum cut-off point in predicting outcome was found to be 3 for REMS model and 2 for RAPS model. The sensitivity and specificity of REMS and RAPS in the mentioned cut offs were 95.93 vs. 85.37 and 77.63 vs. 83.51, respectively, in predicting mortality. Calibration and overall performance of the two models were acceptable.
  
  
  CONCLUSIONS
  The present study showed that adding age and level of arterial oxygen saturation to the variables included in RAPS model can increase its predictive value. Therefore, it seems that REMS could be used for predicting mortality and poor outcome of trauma patients in emergency settings.
authors.affiliation: Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Babak
authors.initials: B
authors.lastname: Nakhjavan-Shahraki
authors.affiliation: Department of Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Masoud
authors.initials: M
authors.lastname: Baikpour
authors.affiliation: Physiology Research Center and Department of Physiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Yousefifard
authors.affiliation: Department of Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Zahra Sadat
authors.initials: ZS
authors.lastname: Nikseresht
authors.affiliation: Department of Emergency Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.
authors.forename: Samaneh
authors.initials: S
authors.lastname: Abiri
authors.affiliation: Department of Community Nutrition, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Jalaledin
authors.initials: J
authors.lastname: Mirzay Razaz
authors.affiliation: Department of Emergency Medicine, Maragheh University of Medical Sciences, Maragheh, Iran.
authors.forename: Gholamreza
authors.initials: G
authors.lastname: Faridaalaee
authors.affiliation: Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Mahboob
authors.initials: M
authors.lastname: Pouraghae
authors.affiliation: Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Sahar
authors.initials: S
authors.lastname: Shirzadegan
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mostafa
authors.initials: M
authors.lastname: Hosseini
keywords: Multiple trauma; decision support techniques; patient outcome assessment; prognosis; trauma severity indices