Evaluation of power of clinical judgment versus REMS and APACHE II models in prediction mortality of emergency department: A Prospective Evaluation Study

Background:Physician in emergency department (ED) are always in a tense situation. Primary judgment of physician plays a decisive role in future patient care because of scoring systems can play an effective and useful role in determining prognosis and taking clinical decisions. THE REMS and APACHEII models were used as an example of these systems and were compared with clinical judgment of emergency medical practitioners. Material and Methods: A prospective cohort study was conducted in the largest emergency referral center in eastern Iran. Patients over 18 years of age with triage levels 1, 2 and 3 to be entered into a study. Evaluation of models from several aspects, overall performance, distinguishing Power and calibration were investigated. Results: A total of 3064 patients only 2205 patients had full details of study and including 53% of men with an average age of 61.8 ± 18.5. Area under curve in THE REMS, APACHEII model and clinical judgment of physician were 0.67 (0.70-0.64), 0.68 (0.71-0.65) and 0.75 (0.78-0.72) respectively. Brier score were 0.179,0.141 and 0.154 respectively. Numbers of observed deaths were 426. Predicted death rates in APACHEII, clinical judgment and THE REMS model were 303, 507, and 619, respectively (13.7%, 22.9% and 28% respectively). Average age of emergency medical residents was 37 and number of Physicians participating in this study was 10 using R studio.Conclusion: In general, APACHEII model was more versatile than other models, However, poor calibration of these models highlights the need for recalibration or modification process before clinical use at individual level. Our study showed that physicians similar to THE REMS model had a conservative behavior in predicting outcome of patients

کلیدواژه ها:

REMS ، APACHE II ، predicting Mortality ، Emergency Department