Iranian Journal of Medical Sciences

Document Type : Review Article


1 Emergency Medicine Research Team, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

2 Research Center for Evidence-Based Medicine, Iranian EBM Center: A Joanna Briggs Institute Affiliated Center, Tabriz University of Medical Sciences, Tabriz, Iran



Background: Emergency Department (ED) physicians often need to quickly assess patients and determine vital signs to prioritize them by the severity of their condition and make optimal treatment decisions. Effective triage requires optimal scoring systems to accelerate and positively influence the treatment of trauma cases. To this end, a variety of scoring systems have been developed to enable rapid assessment of ED patients. The present systematic review and meta-analysis aimed to investigate the accuracy of the Rapid Emergency Medicine Score (REMS) system in predicting the mortality rate in non-surgical ED patients.
Methods: A systematic search of articles published between 1990 and 2020 was conducted using various scientific databases (Medline, Embase, Scopus, Web of Science, ProQuest, Cochrane Library, IranDOC, Magiran, and Scientific Information Database). Both cross-sectional and cohort studies assessing the REMS system to predict mortality in ED settings were considered. Two reviewers appraised selected articles independently using the National Institutes of Health (NIH) quality assessment tool. The random-effects model was used for meta-analysis. I2 index and Q statistic were used to examine heterogeneity between the articles.
Results: The search resulted in 1,310 hits from which, 29 articles were eventually selected. Out of these, for 25 articles, the area under the curve (AUC) value of REMS ranged from 0.52 to 0.986. The predictive power of REMS for the in-hospital mortality rate was high in 19 articles (67.85%) and low in nine articles (32.15%).
Conclusion: The results showed that the REMS system is an effective tool to predict mortality in non-surgical patients presented to the ED. However, further evidence using high-quality design studies is required to substantiate our findings.