Evaluation of the performance of the modified early warning score in a Brazilian public hospital

Abstract

Objective: To evaluate the performance of the modified early warning score (Mews) in a nursing ward for patients in clinical deterioration. Method: This is an analytical, quantitative and predictive study. Mews’ parameters (systolic blood pressure, heart rate, respiratory rate, temperature and level of consciousness) were evaluated every six hours. The following events were reported: death, cardiopulmonary arrest and transfer to intensive care. The evaluations were performed in a hospital of reference in the state of São Paulo, Brazil. Results: A total of 300 patients were included (57 ± 18 years old, males: 65%). There number of combined events was observed to be greater the higher the score’s value (00%; 00%; 01; 09%; 19%; 28%; 89%, respectively, for Mews 0; 1; 2; 3; 4; 5 and 6; p < 0.0001). Mews ≥ 4 was the most appropriate cut-off point for prediction of these events (sensitivity: 87%, specificity: 85% and accuracy: 0.86). Conclusion: Mews properly measured the occurrence of severe events in hospitalized patients of a Brazilian public hospital’s nursing ward. Mews ≥ 4 seems to be the most appropriate cut-off point for prediction of these events.

COVID-19 and aging: Identifying measures of severity

“…The Modified Early Warning Score (MEWS), although still needing accuracy improvement, has an acceptable prognostic value for application in the emergency department. 13 , 26 In our data, MEWS at admission proved to be an independent predictor of mortality, when adjusting for possible confounders, supporting its use in baseline assessment of severity of OAG patients. Interesting, MEWS performed better than EWS-2 in terms of predicting prognosis, although no direct comparison of the 2 scores has, to our knowledge, been already performed in the literature.…”

Clinical impact of implementing a rapid-response team based on the Modified Early Warning Score in wards that offer emergency department support

“…Each study used a different trigger to activate the RRT. We opted to use the MEWS because it is a simple score calculated from the basic vital sign variables and was validated in a pilot study in these same wards [ 7 ]. Scientific evidence has showed that MEWS is an appropriate screening tool for major adverse events in hospitalized patients [ 3 , 12 ].…”

“…There is some controversy about the most appropriate MEWS cut-off point to activate the RRT [ 18 ]. Our investigation used a MEWS ≥ 4 points to activate this system according to a previous pilot study performed by our research group in the same ward [ 7 ]. In our opinion, the MEWS cut-off point should be individualized according to each ward profile.…”

“…We used four points in the MEWS as the cut-off to activate the RRT based on a previous pilot study performed in this same ward [ 7 ]. Fig 1 shows how responses were triggered based on each MEWS value.…”

Identificação da piora do quadro clínico do paciente internado na enfermaria

“…Na Holanda, os pacientes apresentaram média de idade de 61 anos, com prevalência do sexo masculino14 . Um estudo brasileiro realizado em uma enfermaria da Unidade de Emergência mostrou idade média dos pacientes de 57 anos, prevalecendo mais pacientes do sexo masculino, com diagnóstico principal de infecção e comorbidades como hipertensão arterial sistêmica em 30% e diabetes mellitus em 15%35 da amostra.Todos os dados prévios são similares aos do presente estudo em relação à prevalência de comorbidades e à média de idade.O Sistema Único de Saúde (SUS) preconiza o acesso à saúde para todos, porém há uma espera para marcação de consultas e exames, que, muitas vezes, gera o agravamento ou a desistência de usuários do sistema. Há uma regulamentação das prioridades com tempo de espera, variando de 90 dias até 180 dias37 , o que difere, em média, dos usuários da saúde suplementar, que têm maior agilidade para marcação de exames e consultas.…”