Assessment of Icu Admission and Length of Intensive Care Unit Stay in Acute Medical Presentations to the Emergency Department Using the Rapid Emergency Medicine Score (Rems)

Abstract

Background: Efficient triage in the Emergency Department (ED) is essential for optimal resource utilization, particularly for patients requiring Intensive Care Unit (ICU) support. The Rapid Emergency Medicine Score (REMS), derived from routinely available clinical parameters, offers a practical method for early risk stratification in acute medical cases.

Objective: To assess the effectiveness of REMS in predicting ICU admission rates, duration of ICU stay, and the allocation of critical care resources in adult patients with acute medical presentations to the ED.

Methods: A prospective observational study was conducted at the Department of Emergency Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, India. Adults aged ≥18 years presenting with acute medical conditions were enrolled. REMS was calculated on arrival based on six clinical variables: age, heart rate, mean arterial pressure, respiratory rate, Glasgow Coma Scale, and oxygen saturation. Patients were grouped according to REMS scores (≤8 vs. >8). Outcomes measured included ICU admission, length of ICU stay, and categorization of triage resource needs. Data were analyzed using SPSS version 26.0.

Results: Among 578 enrolled patients, those with REMS >8 had significantly higher ICU admission rates and longer ICU stays compared to those with REMS ≤8. The REMS showed good predictive value for ICU resource utilization, with an Area Under the Curve (AUC) of 0.8064 in ROC analysis. High REMS scores correlated with greater triage urgency and allocation of intensive monitoring and interventions.

Conclusion: REMS serves as a valuable triage tool for predicting ICU admission and estimating ICU stay duration in acute medical emergencies. Its application in the ED can aid in prioritizing critically ill patients and optimizing critical care resource allocation.