Evaluation of the rapid emergency medicine score and rapid acute physiology score scoring systems in predicting short-term survival outcomes in geriatric septic shock patients in the emergency department
American Journal of Emergency Medicine, cilt.96, ss.110-115, 2025 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 96
- Basım Tarihi: 2025
- Doi Numarası: 10.1016/j.ajem.2025.06.034
- Dergi Adı: American Journal of Emergency Medicine
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CINAHL, EMBASE, MEDLINE
- Sayfa Sayıları: ss.110-115
- Anahtar Kelimeler: Aging populations, Elderly care, Geriatric medicine, sepsis, Septic shock
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Objective: To evaluate the ability of the Rapid Emergency Medicine Score (REMS) and the Rapid Acute Physiology Score (RAPS) to predict short-term survival among geriatric patients with septic shock. Materials and methods: This observational diagnostic validity study prospectively evaluated patients aged 65 years and older who presented to the emergency department with septic shock. Septic shock was defined as sepsis with persisting hypotension requiring vasopressors to maintain MAP ≥65 mmHg and having a serum lactate level > 2 mmol/L despite adequate volume resuscitation. The definition of sepsis was based on the Sepsis-3 guidelines. The patients were categorized into survivor and mortality groups based on their 30-day all-cause survival status. REMS and RAPS scores were calculated on admission, and their prognostic values were assessed using logistic regression and receiver operator characteristic analysis. Results: A total of 197 patients were included in the study. The 30-day all-cause mortality rate was 59 %. The area under the curve value of REMS was calculated to be 0.705, while that of RAPS was 0.659. A pairwise comparison conducted using the DeLong test revealed that REMS had a statistically significantly higher discriminative power than RAPS (area under the curve difference: 0.046, 95 % confidence interval: 0.005–0.087, p = 0.027). According to the results of separate multivariate analyses performed for REMS and RAPS (Model 1 and Model 2), both scoring systems were independent predictors (p < 0.001 and p = 0.011, respectively). Conclusion: Our findings indicate that REMS has a statistically higher discrimination capacity compared to RAPS. However, both scoring systems have prognostic value in predicting mortality among the geriatric population.