Prognostic significance of emergency department modified early warning score trend in critical ill elderly patients

Kao, Chih-Chun; Chen, Yen-Chia; Hsu, The-Fu; Yen, David Hung-Tsang; Fan, Ju-Sing

doi:10.1016/j.ajem.2021.01.047

Cited by 12 publications

(19 citation statements)

References 30 publications

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“…The countries of origin were Turkey ( n = 8) [ 33 , 34 , 37 – 39 , 42 , 45 , 48 ], United States ( n = 3) [ 41 , 43 , 49 ], United Kingdom ( n = 3) [ 44 , 50 , 51 ], Australia ( n = 3) [ 19 , 20 , 57 ], China ( n = 3) [ 35 , 60 , 62 ], Italy ( n = 2) [ 58 , 61 ], Indonesia ( n = 2) [ 46 , 47 ] and one study each from Finland [ 32 ], Demark [ 54 ], Norway [ 36 ], Netherlands [ 40 ]. Switzerland [ 55 ], Brazil [ 52 ], Singapore [ 53 ], Taiwan [ 59 ], and Korea [ 56 ].…”

Section: Resultsmentioning

confidence: 99%

“…All studies were observational in nature, with 17 prospective studies [32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48] and 16 retrospective studies [19,20,[49][50][51][52][53][54][55][56][57][58][59][60][61][62]. Thirty-two studies were single site studies [19,20,[32][33][34][35][36][37][38][39][40][41][43][44][45][46][47][48]…”

Section: Study Characteristicsmentioning

confidence: 99%

“…• 48 h (n = 3) [54,57,61] • 5 days (n = 3) [33,36,37], 7 days (n = 3) [57,59,61] • 14 days (n = 1) [33] • 28 days (n = 3) [33,39,57], 30 days (n = 7) [32,36,40,48,49,53,59] • 90 days (n = 1) [36] • Not reported (n = 1) [47] ICU admission (n = 14) Patients admitted to ICU had higher aggregate scores than those not admitted to ICU and this was the case for MEWS [34,35,37,42,45], NEWS [32,40], PEWS on ED arrival [43] and on ED discharge [41,43], BEWS [54] and REMS [42] on ED arrival; NEWS at 1-h of ED care [40] and NEWS at ED discharge [40]. The majority (52.5%) of patients admitted to ICU had MEWS = 2-3 and no patient with MEWS ≥7 was admitted to ICU [52].…”

Section: Track and Trigger Scoringmentioning

confidence: 99%

“…One study showed that MEWS progression (increasing scores) was associated with significantly higher 24-h APACHE-II scores [59]. One study showed that severely injured patients had significantly higher MEWS and MEWS-A scores on ED arrival than less severely injured patients [62].…”

Section: Track and Trigger Scoringmentioning

confidence: 99%

“…• Initial and 24-h ICU APACHE-II scores (n = 1) [59] • Injury severity (n = 1) [62] Length of stay (n = 2) The hospital length of stay studies had conflicting results:…”

Section: Track and Trigger Scoringmentioning

confidence: 99%

See 4 more Smart Citations

Systems for recognition and response to deteriorating emergency department patients: a scoping review

Considine

Fry

Curtis

et al. 2021

Scand J Trauma Resusc Emerg Med

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Background Assessing and managing the risk of clinical deterioration is a cornerstone of emergency care, commencing at triage and continuing throughout the emergency department (ED) care. The aim of this scoping review was to assess the extent, range and nature of published research related to formal systems for recognising and responding to clinical deterioration in emergency department (ED) patients. Materials and methods We conducted a scoping review according to PRISMA-ScR guidelines. MEDLINE complete, CINAHL and Embase were searched on 07 April 2021 from their dates of inception. Human studies evaluating formal systems for recognising and responding to clinical deterioration occurring after triage that were published in English were included. Formal systems for recognising and responding to clinical deterioration were defined as: i) predefined patient assessment criteria for clinical deterioration (single trigger or aggregate score), and, or ii) a predefined, expected response should a patient fulfil the criteria for clinical deterioration. Studies of short stay units and observation wards; deterioration during the triage process; system or score development or validation; and systems requiring pathology test results were excluded. The following characteristics of each study were extracted: author(s), year, design, country, aims, population, system tested, outcomes examined, and major findings. Results After removal of duplicates, there were 2696 publications. Of these 33 studies representing 109,066 patients were included: all were observational studies. Twenty-two aggregate scoring systems were evaluated in 29 studies and three single trigger systems were evaluated in four studies. There were three major findings: i) few studies reported the use of systems for recognising and responding to clinical deterioration to improve care of patients whilst in the ED; ii) the systems for recognising clinical deterioration in ED patients were highly variable and iii) few studies reported on the ED response to patients identified as deteriorating. Conclusion There is a need to re-focus the research related to use of systems for recognition and response to deteriorating patients from predicting various post-ED events to their real-time use to improve patient safety during ED care.

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Section: Resultsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Track and Trigger Scoringmentioning

confidence: 99%

Section: Track and Trigger Scoringmentioning

confidence: 99%

“…• Initial and 24-h ICU APACHE-II scores (n = 1) [59] • Injury severity (n = 1) [62] Length of stay (n = 2) The hospital length of stay studies had conflicting results:…”

Section: Track and Trigger Scoringmentioning

confidence: 99%

See 3 more Smart Citations

Systems for recognition and response to deteriorating emergency department patients: a scoping review

Considine

Fry

Curtis

et al. 2021

Scand J Trauma Resusc Emerg Med

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Prediction of clinical deterioration risk at 8 hours after arrival in emergency department in non‐traumatic patients using trends in modified early warning score level

Lin,

Chang,

Lin

et al. 2024

Hong Kong j. emerg. med.

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BackgroundImproving the quality of medical care in hospitals is a major priority for all departments. The early warning score (EWS) trend is an effective early risk stratification tool that reflects the changes in patient condition and allows better assessment of deterioration risk.ObjectiveThe aim of this study was to investigate whether utilizing the trend of the modified early warning score (MEWS) level within 4 h of a patient's arrival in the emergency department (ED) could identify patients at risk of clinical deterioration at 8 h after arrival in the ED.MethodsWe conducted a retrospective observational study of non‐trauma patients who had at least two vital sign measurements (Glasgow Coma Scale score, heart rate, blood pressure, respiratory rate, and body temperature) within 8 h of arriving in the ED. The primary outcome was patients who had MEWS ≥ 4 at 8 h after arrival in the ED. We performed multivariate logistic regression analysis using age, sex, MEWS level at arrival in the ED, MEWS level within 4 h after arrival in the ED, and MEWS level trend over time.ResultsAmong the 5825 patients, 680 (11.7%) were at risk of deterioration at 8 h after arrival in the ED. To predict the risk of deteriorating conditions (MEWS ≥ 4), utilizing the MEWS level trend within 4 h of arrival in the ED was more effective in identifying patients at risk of deterioration after 8 h of arrival in the ED compared to using a single MEWS value during the ED stay. The corresponding areas under the receiver operating characteristic curve were 0.756 (95% confidence interval (CI) 0.734–0.778) and 0.846 (95% CI 0.827–0.865), respectively (p < 0.01).ConclusionsThe proposed trend‐based predictive model for MEWS levels can alert healthcare personnel regarding patients at increased risk of deterioration (MEWS ≥ 4), potentially reducing mortality rates during ED stays.

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Comparison between various scoring systems in predicting the need for intensive care unit admission of acute pesticide-poisoned patients

El-Sarnagawy

Abdelnoor

Abuelfadl

et al. 2022

Environ Sci Pollut Res

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Prognostic significance of emergency department modified early warning score trend in critical ill elderly patients

Cited by 12 publications

References 30 publications

Systems for recognition and response to deteriorating emergency department patients: a scoping review

Systems for recognition and response to deteriorating emergency department patients: a scoping review

Prediction of clinical deterioration risk at 8 hours after arrival in emergency department in non‐traumatic patients using trends in modified early warning score level

Comparison between various scoring systems in predicting the need for intensive care unit admission of acute pesticide-poisoned patients

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