The Value of Physiological Scoring Criteria in Predictingthe In-Hospital Mortality of Acute Patients; a Systematic Review and Meta-Analysis

There is no comprehensive meta-analysis on the value of physiological scoring systems in pre-dicting the mortality of critically ill patients. Therefore, the present study intended to conduct a systematicreview and meta-analysis to collect the available clinical evidence on the value of physiological scoring systemsin predicting the in-hospital mortality of acute patients.

An extensive search was performed on Med-line, Embase, Scopus, and Web of Science databases until the end of year 2020. Physiological models includedRapid Acute Physiology Score (RAPS), Rapid Emergency Medicine Score (REMS), modified REMS (mREMS), andWorthing Physiological Score (WPS). Finally, the data were summarized and the findings were presented as sum-mary receiver operating characteristics (SROC), sensitivity, specificity and diagnostic odds ratio (DOR).

Data from 25 articles were included. The overall analysis showed that the area under the SROC curve of REMS,RAPS, mREMS, and WPS criteria were 0.83 (95% CI: 0.79-0.86), 0.89 (95% CI: 0.86-0.92), 0.64 (95% CI: 0.60-0.68)and 0.86 (95% CI: 0.83-0.89), respectively. DOR for REMS, RAPS, mREMS and WPS models were 11 (95% CI: 8-16), 13 (95% CI: 4-41), 2 (95% CI: 2-4) and 17 (95% CI: 5-59) respectively. When analyses were limited to traumapatients, the DOR of the REMS and RAPS models were 112 and 431, respectively. Due to the lack of sufficientstudies, it was not possible to limit the analyses for mREMS and WPS.

The findings of the presentstudy showed that three models of RAPS, REMS and WPS have a high predictive value for in-hospital mortality.In addition, the value of these models in trauma patients is much higher than other patient settings.