Martin Winardi1, Zulkfili Amin2, Ceva W. Pitoyo2, Andi AW Ramlan3, Esthika Dewiasty4
1Departemen Ilmu Penyakit Dalam FKUI/RSCM
2Divisi Pulmonologi dan Perawatan Penyakit Kritis, Departemen Ilmu Penyakit Dalam FKUI/RSCM 3Departemen Anestesiologi dan Perawatan Intensif FKUI/RSCM
4Divisi Geriatri, Departemen Ilmu Penyakit Dalam FKUI/RSCM
ABSTRACT
Background: Identifying the mortality risk of nonsurgical emergency department (ED) patients is essential as a consequence of increasing number of patients with diverse disease severity. Rapid Emergency Medicine Score (REMS) was developed to predict patient’s mortality in a short time, therefore it can help doctors to make clinical decision based on objective data. Difference in patients’ characteristic may influence the score’s performance value, therefore validation of REMS is needed before deciding to apply this system in Indonesia.
Objective: To evaluate calibration and discrimination performance of REMS in predicting mortality of nonsurgical ED patients in Cipto Mangunkusumo Hospital.
Methods: This is a prospective cohort study of nonsurgical patients who went to ED of Cipto Mangunkusumo Hospital in October-December 2012. Age, body temperature, mean arterial pressure, heart rate, respiratory rate, peripheral oxygen saturation, and Glasgow coma scale were obtained when the patient arrived at emergency room to perform the calculation of REMS. Outcome was assessed when patients were discharged from the hospital (alive or dead). Calibration was evaluated with calibration plot and Hosmer-Lemeshow test. Discrimination was evaluated with area under the curve (AUC).
Results: A total of 815 nonsurgical patients went to ED of Cipto Mangunkusmo Hospital during the study period. As many as 741 (90.9%) patients were followed until the outcome was reached. Mortality was observed in 145 patients (19.57%). Calibration plot of REMS showed r = 0.913 and Hosmer-Lemeshow test showed p = 0.665. Discrimination was shown by ROC curve with AUC 0.77 (95% CI 0.723; 0.817).
Conclusion: Rapid Emergency Medicine Score showed a good calibration and discrimination performance in predicting mortality of nonsurgical emergency department patients in Cipto Mangunkusumo Hospital.
Key Words: Validation, rapid emergency medicine score, mortality, non surgical emergency.
