Rapid Emergency Medicine Score (REMS)

REMS Calculator

Age (years)

years

Mean Arterial Pressure

mmHg

Heart Rate

bpm

Respiratory Rate

/min

SpO2

Glasgow Coma Scale

Total REMS Score: –

Awaiting input

Enter at least one parameter to compute.

Predicts in-hospital mortality in nonsurgical adult patients presenting to the ED.

Why Use

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.

When to Use

Critically ill patients, where in-hospital mortality prediction may help guide treatment modalities. Not validated for pediatric patients.

Formula

Addition of the selected points: Variable Points Age, years <45 0 45-54 2 55-64 3 65-74 5 >74 6 Mean arterial pressure, mmHg >159 4 130-159 3 110-129 2 70-109 0 50-69 2 ≤49 4 Heart rate, beats per minute >179 4 140-179 3 110-139 2 70-109 0 55-69 2 40-54 3 ≤39 4 Respiratory rate, breaths per minute >49 4 35-49 3 25-34 1 12-24 0 10-11 1 6-9 2 ≤5 4 Peripheral oxygen saturation <75% 4 75-85% 3 86-89% 1 >89% 0 Glasgow Coma Scale <5 4 5-7 3 8-10 2 11-13 1 >13 0

Pearls / Pitfalls

Not validated for pediatric patients.

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.

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).

More Information

Interpretation: REMS In-hospital mortality 0-2 0% 3-5 1% 6-9 3% 10-11 4% 12-13 10% 14-15 17% 16-17 38% 18-19 75% 20-21 56% 22-23 66% 24-26 100% Note that <0.3% of patients had scores >19, which may account for the paradoxical apparent decrease in events between scores of 19 and scores >19.