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      Calc Function

    • Calcs that help predict probability of a diseaseDiagnosis
    • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
    • Disease is diagnosed: prognosticate to guide treatmentPrognosis
    • Numerical inputs and outputsFormula
    • Med treatment and moreTreatment
    • Suggested protocolsAlgorithm

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    Patent Pending

    Rapid Emergency Medicine Score (REMS)

    Predicts in-hospital mortality in nonsurgical adult patients presenting to the ED.
    Favorite
    When to Use
    Pearls/Pitfalls
    Why Use

    • Critically ill patients, where in-hospital mortality prediction may help guide treatment modalities.

    • Not validated for pediatric patients.

    Not validated for pediatric patients.

    • May not add to clinician gestalt, but can be useful in the prehospital setting for determining whether a patient would benefit from rapid access to advanced life support services.

    • Superior (Olsson 2004) to the Rapid Acute Physiology Score (RAPS) (Rhee 1987) and non-inferior to APACHE II (Olsson 2003).

    • Calculated with values obtained out of hospital, or in hospital without lab studies.

    • Helps guide aggressiveness of treatment with parameters routinely acquired in the prehospital setting.

    <45
    0
    45-54
    +2
    55-64
    +3
    65-74
    +5
    >74
    +6
    >159
    +4
    130-159
    +3
    110-129
    +2
    70-109
    0
    50-69
    +2
    ≤49
    +4
    >179
    +4
    140-179
    +3
    110-139
    +2
    70-109
    0
    55-69
    +2
    40-54
    +3
    ≤39
    +4
    >49
    +4
    35-49
    +3
    25-34
    +1
    12-24
    0
    10-11
    +1
    6-9
    +2
    ≤5
    +4
    <75%
    +4
    75-85%
    +3
    86-89%
    +1
    >89%
    0
    <5
    +4
    5-7
    +3
    8-10
    +2
    11-13
    +1
    >13
    0

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    High risk (REMS ≥3): patient may need aggressive treatment.

    Low risk (REMS <3): patient may be appropriate to triage for routine treatment (in Olsson 2004, all patients with REMS <3 survived).

    Management

    • Mortality rapidly increases above a score of 10. Consider more aggressive treatment in patients with higher scores (in conjunction with patient wishes and clinical judgment).
    • Clinical judgment of a patient’s presentation should always be used to determine need for advanced interventions.
    Content Contributors
    • Mario Leone, NRP, NICP
    Reviewed By
    • Greg Tichenor, MD
    About the Creator
    Dr. Thomas Olsson
    Are you Dr. Thomas Olsson?
    Content Contributors
    • Mario Leone, NRP, NICP
    Reviewed By
    • Greg Tichenor, MD