Assessing prognosis with modified early warning score, rapid emergency medicine score and worthing physiological scoring system in patients admitted to intensive care unit from emergency department (original) (raw)
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World journal of emergency medicine, 2013
This study was undertaken to validate the use of the modified early warning score (MEWS) as a predictor of patient mortality and intensive care unit (ICU)/ high dependency (HD) admission in an Asian population. The MEWS was applied to a retrospective cohort of 1 024 critically ill patients presenting to a large Asian tertiary emergency department (ED) between November 2006 and December 2007. Individual MEWS was calculated based on vital signs parameters on arrival at ED. Outcomes of mortality and ICU/HD admission were obtained from hospital records. The ability of the composite MEWS and its individual components to predict mortality within 30 days from ED visit was assessed. Sensitivity, specificity, positive and negative predictive values were derived and compared with values from other cohorts. A MEWS of !4 was chosen as the cut-off value for poor prognosis based on previous studies. A total of 311 (30.4%) critically ill patients were presented with a MEWS !4. Their mean age was 6...
International Journal of Emergency Medicine, 2015
Background: The Rapid Emergency Medicine Score (REMS) and Worthing Physiological Scoring system (WPS) have been developed for predicting in-hospital mortality in nonsurgical emergency department (ED) patients. The prognostic performance of the scoring systems in independent populations has not been clear. The aim of the study is to evaluate the prognostic accuracy of REMS and WPS systems in the estimation of 30-day mortality risk among medical patients in ED. Methods: The study was designed as a prospective investigation, with the setting being the ED of the National Hospital of Can Tho, Vietnam. We enrolled medical patients aged 16+ years who met the study entry criteria. Clinical data were obtained as required for each scoring system. The primary outcome was mortality within 30 days since hospitalization. The association between each scoring system and mortality was assessed by the hazard ratio (HR) of the Cox's proportional hazard model. Results: The study involved 1746 patients, average age 65.9 years (SD 17). During the period of follow-up, 172 patients (9.9 %) died. The risk of 30-day mortality was increased by 30 % for each additional REMS unit (HR: 1.28; 95 % confidence interval (CI): 1.23-1.34) and by 60 % for each additional WPS unit (HR: 1.6; 95 % CI: 1.5-1.7). The AUC of the REMS was 0.71 (95 % CI: 0.67-0.76) which was significantly lower than that of the WPS (0.80; 95 % CI: 0.76-0.83). Conclusions: Both REMS and WPS have good prognostic value in the prediction of death in ED patients. The WPS appeared to have a better prognostic performance than the REMS system.
Acute medicine
We evaluated the effectiveness of MEWS and biochemical parameters in predicting outcomes for acute medical admissions. Data from consecutive admissions to the Acute Medical Unit (AMU) of National Hospital of Sri Lanka were collected. C-reactive protein (CRP), albumin, white cell count, platelet count and haemoglobin values were collected. Adverse endpoints were HDU/ICU admission,cardio-respiratory emergency/resuscitation and death. A MEWS score of >=5 together with increasing age,pulse rate, respiratory rate, AVPU score, CRP,CRP/Albumin ratio and reduced platelet and albumin levelall increased the odds of reaching "adverse endpoints". Adding a score for biochemical parameters increased the area under the ROC curve for reaching "adverse endpoints" Biochemical parameters better predicted length of hospital stay and adverse outcomes. A combined scoring system improved the sensitivity of prediction.
The Modified Early Warning Score (MEWS) is a simple physiological scoring system, which can easily be applied at the bedside. The ability of MEWS to identify patients at risk of deterioration in a busy ward was investigated. Method: In a prospective cohort study, we applied MEWS to patients admitted to the 16-bed emergency department observation ward (EDOW) of a tertiary teaching hospital. Results: Data on 427 consecutive EDOW admissions were collected from 7 June to 4 July 2004. Main outcome measures were death, intensive care unit (ICU) admission and inpatient hospital admission. Scores of > 4 were associated with increased risk of death (OR 54.4, 95% CI = 4.7−633.7), ICU admission (OR 12.7, 95% CI = 1.1−147.3) and hospital admission (OR 9.5, 95% CI = 3.3−27.9). Conclusion: MEWS is suitable for bedside application in an EDOW setting and may help identify patients at risk of deterioration who require increased levels of care as hospital inpatients and in ICU. Where experienced staff is not available to closely monitor patients in an EDOW, the use of the MEWS system may aid close monitoring and identification of high-risk patients.
International Journal of Nursing Practice, 2018
Aim: To determine the value of the Modified Early Warning Score (MEWS) for general ward patients and its potential use as an alarm tool for ward nurses. Methods: A combined prospective‐retrospective observational study was conducted with 153 patients in a university hospital (2013‐2014). All patients were admitted to the intensive care unit (ICU) from general wards. Parameters retrospectively studied were 5 MEWS values at 4 hourly intervals, up to 20 hours before ICU admission. Parameters prospectively studied were ICU length of stay, ICU mortality, and mortality after ICU discharge. Results: Most frequent severe adverse events were acute respiratory failure (39.9%) and septic shock (20.3%). Modified Early Warning Score increased gradually during the last 20 hours, and most patients remained in the wards, above a cut‐off point ≥7 recorded at 4 hours before admission. Significant associations between latest MEWS score and ICU mortality and ICU length of stay were found. MEWS score≥ 7 hours before admission was highly associated with increased ICU and hospital mortality. Conclusion: Patient deterioration in general wards can result in severe adverse events. Modified Early Warning Score is a strong predictor of outcome and may be used as a monitoring tool for potentially avoidable deaths and unplanned admissions to ICU.
Nigerian Journal of Clinical Practice, 2016
Introduction: The purpose of this study is to assess and compare the discriminatory ability of the Glasgow coma scale (GCS)-age-systolic blood pressure (GAP) score and modified early warning scoring system (mEWS) score for 4-week mortality, for the patients being in the triage category 1 and 2 who refer to Emergency Department (ED). Methods: Five hundred and two nontraumatic cases being in the triage category 1 and 2 who were ≥18-year-old and who referred to ED were assessed prospectively. Reason of referral, fashion of referral, age, gender, vital signs, GCS/alert/verbal/painful/unresponsive scores, consultations, diagnoses, and treatments and final outcome (hospitalization, transfer, discharge, treatment rejection, and exitus) were recorded. The mEWS and GAP scores and the mortality ratios of the cases were calculated by observing both in ED and 4-week survivals of the patients. Results: When the mEWS and GAP scores were compared in the prediction of 4-week mortality, no statistically significant difference was found between them (P > 0.05). The power of mortality estimation was found significant for both scoring systems (for both; P < 0.001). Conclusion: GAP score with a simple use being a score developed for the estimation of mortality of trauma patients seems to be usable also for the nontraumatic patients with triage category 1-2 in the ED.
Frontiers in Medicine
BackgroundModified Early Warning Score (MEWS) and National Early Warning Score (NEWS) are widely used in predicting the mortality and intensive care unit (ICU) admission of critically ill patients. This study was conducted to evaluate and compare the prognostic value of NEWS and MEWS for predicting ICU readmission, mortality, and related outcomes in critically ill patients at the time of ICU discharge.MethodsThis multicenter, prospective, observational study was conducted over a year, from April 2019 to March 2020, in the general ICUs of two university-affiliated hospitals in Northwest Iran. MEWS and NEWS were compared based on the patients’ outcomes (including mortality, ICU readmission, time to readmission, discharge type, mechanical ventilation (MV), MV duration, and multiple organ failure after readmission) using the univariable and multivariable binary logistic regression. The receiver operating characteristic (ROC) curve was used to determine the outcome predictability of MEWS...
BioMed Research International
Background.A variety of scoring systems have been introduced for use in both the emergency department (ED) such as WPS, REMS, and MEWS and the intensive care unit (ICU) such as APACHE II, SAPS II, and SOFA for risk stratification and mortality prediction. However, the performance of these models in the ICU remains unclear and we aimed to evaluate and compare their performance in the ICU. Methods. This multicenter retrospective cohort study was conducted on severely ill patients admitted to the ICU directly from the ED in seven tertiary hospitals in Iran from August 2018 to August 2020. We evaluated all models in terms of discrimination (AUROC), the balance between positive predictive value and sensitivity (AUPRC), calibration (Hosmer-Lemeshow test and calibration plots), and overall performance using the Brier score (BS). The endpoint was considered inhospital mortality. Results. Among the 3,455 patients included in the study, 54.4% of individuals were male ( N = 1,879 ) and 26.5% d...
BMC Emergency Medicine
Background Medical scoring systems are potentially useful to make optimal use of available resources. A variety of models have been developed for illness measurement and stratification of patients in Emergency Departments (EDs). This study was aimed to compare the predictive performance of the following six scoring systems: Simple Clinical Score (SCS), Worthing physiological Score (WPS), Rapid Acute Physiology Score (RAPS), Rapid Emergency Medicine Score (REMS), Modified Early Warning Score (MEWS), and Routine Laboratory Data (RLD) to predict in-hospital mortality. Methods A prospective single-center observational study was conducted from March 2016 to March 2017 in Edalatian ED in Emam Reza Hospital, located in the northeast of Iran. All variables needed to calculate the models were recorded at the time of admission and logistic regression was used to develop the models’ prediction probabilities. The Area Under the Curve for Receiver Operating Characteristic (AUC-ROC) and Precision...
Resuscitation
The National Early Warning System (NEWS) is based on vital signs; the Laboratory Decision Tree Early Warning Score (LDT-EWS) on laboratory test results. We aimed to develop and validate a new EWS (the LDTEWS:NEWS risk index) by combining the two and evaluating the discrimination of the primary outcome of unanticipated intensive care unit (ICU) admission or in-hospital mortality, within 24 h. Methods: We studied emergency medical admissions, aged 16 years or over, admitted to Oxford University Hospitals (OUH) and Portsmouth Hospitals (PH). Each admission had vital signs and laboratory tests measured within their hospital stay. We combined LDT-EWS and NEWS values using a linear time-decay weighting function imposed on the most recent blood tests. The LDTEWS:NEWS risk index was developed using data from 5 years of admissions to PH, and validated on a year of data from both PH and OUH. We tested the risk index's ability to discriminate the primary outcome using the c-statistic. Results: The development cohort contained 97,933 admissions (median age = 73 years) of which 4723 (4.8%) resulted inhospital death and 1078 (1.1%) in unanticipated ICU admission. We validated the risk index using data from PH (n = 21,028) and OUH (n = 16,383). The risk index showed a higher discrimination in the validation sets (c-statistic value (95% CI)) (PH, 0.901 (0.898-0.905); OUH, 0.916 (0.911-0.921)), than NEWS alone (PH, 0.877 (0.873-0.882); OUH, 0.898 (0.893-0.904)). Conclusions: The LDTEWS:NEWS risk index increases the ability to identify patients at risk of deterioration, compared to NEWS alone.