Rapid Emergency Medicine Score (REMS)
Predicts in-hospital mortality in non-traumatic adult ED patients using 6 physiological variables: age, MAP, HR, RR, SpO₂, and GCS
Score interpretation
REMS 0–2: Very low predicted in-hospital mortality (<1%).
→ Standard ED assessment. Consider early discharge pathway if appropriate.
REMS 3–5: Low predicted mortality (~5%).
→ Admit for monitoring. Standard ward-level care.
REMS 6–8: Moderate predicted mortality (~10–15%).
→ Consider HDU-level monitoring. Senior ED/medical review. Identify and treat reversible causes.
REMS 9–12: High predicted mortality (~25–40%).
→ HDU/ICU admission. Early resuscitation. ITU team review. Goals-of-care discussion.
REMS ≥ 13: Very high predicted mortality (>50%).
→ Urgent ICU/resuscitation. Escalate immediately. Palliative care team involvement if appropriate. Family notification.
Interpretation bands for the REMS. Apply clinical judgement and local guidance.
References
- Olsson T, Terent A, Lind L. Rapid Emergency Medicine Score: a new prognostic tool for in-hospital mortality in nonsurgical emergency department patients. J Intern Med. 2004;255(5):579–587.
Related
Curated clinical cross-links plus same-class fallbacks.
- Labetalol (IV — Hypertensive Emergency) · Combined Alpha-1 and Beta-Adrenergic Blocker
- Labetalol (IV — Hypertensive Emergency) · Combined alpha and beta blocker
- Tenecteplase · Cardiovascular Emergency
- Tirofiban · Cardiovascular Emergency
- Terlipressin · Gastrointestinal Emergency
- Octreotide · Gastrointestinal Emergency
- Difficult Airway Algorithm (DAS) · DAS 2015; Royal College of Anaesthetists
- Major Haemorrhage Protocol · NICE NG24; UK MHP guidelines
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
Featured in these MRCEM clinical pathways
The REMS is covered in detail — with RCEM/NICE evidence base, indications and pitfalls — in the following exam-focused pathways on our sister siteReviseMRCEM.
MRCEM Primary / Intermediate / OSCE candidates: each pathway includes exam-style questions, RCEM/NICE citations, and FAQ summaries.
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.