Accuracy of Modified Early Warning Scores for Predicting Mortality in Hospital: A Systematic Review and Meta-analysis

Suwanpasu, Sunee; Sattayasomboon, Youwanuch

doi:10.21767/2471-8505.100029

Cited by 13 publications

(10 citation statements)

References 29 publications

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“…Perera[ 24 ] also reported that 89.5% of patients who died were having mews score more than 5. A study by Suwanpasu and Sattayasomboon[ 27 ] also reported similar findings. In contrast Leong[ 19 ] MEWS to be a poor predictor of mortality in critically ill patients in hospital emergency department.…”

Section: Discussionsupporting

confidence: 66%

Prediction of hospital outcome in emergency medical admissions using modified early warning score (MEWS)

Bhatnagar¹,

Sirohi²,

Dubey³

2021

Journal of Family Medicine and Primary Care

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Objective: To evaluate the applicability of modified early warning (MEWS) Score for prediction of hospital outcomes of medical emergency patients. Design: Prospective hospital based observational study. Setting: A tertiary care level medicine emergency unit in a medical college of North India. Study Population: 300 Patients admitted in medicine emergency. Method: Patients of both sexes of age more than 18 years who were admitted in medical emergency unit at MMIMSR, Ambala were evaluated. Patients who were in cardiac arrest at arrival and those who died within the first 24 hours were excluded and 300 patients were included. Modified Early Warning Score based on physiological parameters was recorded at admission for each patient and monitored over the next 24 hours in the emergency unit. Hospital outcome of the patient in terms of mortality, need for critical care, prolonged stay and uneventful discharge were recorded and correlated with MEWS scores over the first 24 hours in the emergency unit. Receiver Operating Characteristic (ROC) curves was generated to evaluate the utility of MEWS as a tool to predict patient outcome in medical emergency setting. Result: Of the 300 patients studied, the mean age of patients was 49 years, and the majority of the patients were male (61%). A MEWS Score of >5 at 24 hours of admission was associated significantly with in-hospital mortality of patients ( p < 0.0001). The ROC (Receiver Operator Characteristic) curve revealed that in those patients who had a 24 hours MEWS >/= 5, the area under curve was (AUC) = 0.9. (95% CI: 0.95-0.98). Thus, MEWS was an effective predictor of in hospital mortality with sensitivity (78%) and specificity (94%). Conclusion: MEWS, a scoring system based on easily recordable physiological parameters can be used as an effective tool to triage and monitor patients in medical emergency units, to identify patients who are at greater risk of clinical deterioration and need close monitoring or early transfer for critical care or other timely interventions. Thus, application of MEWS in medical emergency units can be a useful tool to improve patient care, ensure optimal utilization of resources and prevent inappropriate discharge or neglect of sick patients.

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Section: Discussionsupporting

confidence: 66%

Prediction of hospital outcome in emergency medical admissions using modified early warning score (MEWS)

Bhatnagar¹,

Sirohi²,

Dubey³

2021

Journal of Family Medicine and Primary Care

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“…As described in previous studies [39][40][41] , we assessed the discriminative power of the prediction score (ageadjusted qSOFA) for identifying at-risk pediatric patients by calculating AUC. An AUC above 0.7 was considered to be acceptable and useful 34,40 .…”

Section: Discussionmentioning

confidence: 99%

Age-adjusted quick Sequential Organ Failure Assessment score for predicting mortality and disease severity in children with infection: a systematic review and meta-analysis

Eun

Kim

et al. 2021

Sci Rep

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We assessed the diagnostic accuracy of the age-adjusted quick Sequential Organ Failure Assessment score (qSOFA) for predicting mortality and disease severity in pediatric patients with suspected or confirmed infection. We conducted a systematic search of PubMed, EMBASE, the Cochrane Library, and Web of Science. Eleven studies with a total of 172,569 patients were included in the meta-analysis. The pooled sensitivity, specificity, and diagnostic odds ratio of the age-adjusted qSOFA for predicting mortality and disease severity were 0.69 (95% confidence interval [CI] 0.53–0.81), 0.71 (95% CI 0.36–0.91), and 6.57 (95% CI 4.46–9.67), respectively. The area under the summary receiver-operating characteristic curve was 0.733. The pooled sensitivity and specificity for predicting mortality were 0.73 (95% CI 0.66–0.79) and 0.63 (95% CI 0.21–0.92), respectively. The pooled sensitivity and specificity for predicting disease severity were 0.73 (95% CI 0.21–0.97) and 0.72 (95% CI 0.11–0.98), respectively. The performance of the age-adjusted qSOFA for predicting mortality and disease severity was better in emergency department patients than in intensive care unit patients. The age-adjusted qSOFA has moderate predictive power and can help in rapidly identifying at-risk children, but its utility may be limited by its insufficient sensitivity.

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“…Conversely, the cut-off points in the ED are often similar to the cut-off points used in in-hospital settings suggesting that EWS scores can be compared between the ED and in-hospital wards, whereas this comparison becomes less valid when it is conducted against the pre-hospital setting (51). In our review, NEWS2 with a cut-off point of 5, 7 or 9 and NEWS with a cut-off point of 7 had similar predictability.…”

Section: Discussionmentioning

confidence: 99%

The use of Early Warning System Scores in Pre-Hospital and Emergency Department Settings to Predict Clinical Deterioration: s Systematic Review and Meta-Analysis

Guan

Lee

Begg

et al. 2021

Preprint

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Background: It is unclear which Early Warning System (EWS) score best predicts in-hospital deterioration when applied in the emergency department (ED) or pre-hospital setting. Methods: This systematic review and meta-analysis assessed the predictive abilities of five commonly used EWS scores: National Early Warning Score (NEWS) and its updated version NEWS2, Modified Early Warning Score (MEWS), Rapid Acute Physiological Score (RAPS) and Cardiac Arrest Risk Triage (CART). Outcomes of interest included admission to ICU, up-to-≥3-day and 30-day mortality. Pooled estimates were calculated using DerSimonian and Laird random-effects models, constructed by type of EWS score, cut-off points, outcomes, and study setting. Risk of bias was assessed using the Newcastle-Ottawa Scale. Meta-regressions investigated between study heterogeneity. Funnel plots tested for publication bias. Results: A total of 11,565 articles was identified, of which 15 were included. Eight and seven articles conducted in the ED and pre-hospital settings, respectively. In the ED, MEWS and NEWS at cut-off points of 3, 4, or 6 had similar pooled diagnostic odds ratios (DOR) to predict 30-day mortality, ranging from 4.05 (Confidence Interval (CI) 2.35–6.99) to 6.48 (95% CI 1.83–22.89), p = 0.757. The ability of MEWS (cut-off point ≥ 3) to predict ICU admission had a similar pooled DOR of 5.54 (95% CI 2.02–15.21). In the pre-hospital setting, EWS scores failed to predict 30-day mortality. Using high cut-off points of 5, 7, or 9, their predictability improved when assessing up-to-≥3-day mortality with DOR ranging from 11.60 (95%, CI 9.75–13.88) to 20.37 (95% CI 13.16–31.52).Publication bias was not detected. Participants’ age explained 92% of between-study variance. Conclusion: EWS scores’ predictability of clinical deterioration improves when applied on patient populations that are already in the ED or hospital. The high thresholds used and the scores’ failure to predict 30-day mortality make them less suited for use in the pre-hospital setting.

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Accuracy of Modified Early Warning Scores for Predicting Mortality in Hospital: A Systematic Review and Meta-analysis

Cited by 13 publications

References 29 publications

Prediction of hospital outcome in emergency medical admissions using modified early warning score (MEWS)

Prediction of hospital outcome in emergency medical admissions using modified early warning score (MEWS)

Age-adjusted quick Sequential Organ Failure Assessment score for predicting mortality and disease severity in children with infection: a systematic review and meta-analysis

The use of Early Warning System Scores in Pre-Hospital and Emergency Department Settings to Predict Clinical Deterioration: s Systematic Review and Meta-Analysis

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