Prognostic value of Modified Early Warning Score generated in a Chinese emergency department: a prospective cohort study

Xie, Xiaohua; Huang, Wenlong; Liu, Qiongling; Tan, Wanlong; Lu, Pan; Wang, Lei; Zhang, Jian; Wang, Yunyun; Zeng, Yingchun

doi:10.1136/bmjopen-2018-024120

Cited by 28 publications

(46 citation statements)

References 26 publications

(17 reference statements)

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“…The conventional MEWS has been applied for identifying mortality risk and determining trauma severity. The MEWS was previously reported to be an excellent predictor of in-hospital mortality because the MEWS achieves high area under ROC (AUROC ranges from 0.83 to 0.90 in Xie et al (2018) , Jiang, Jiang & Mao (2019) , and Smith et al, 2013 ), although the performance may decrease for elderly patients ( Mitsunaga et al, 2019 ). However, the performance of the MEWS in identifying injury severity is moderate (AUROC <0.8).…”

Section: Discussionmentioning

confidence: 99%

“…Given the simplicity and speed required for tools to be effect in triaging multiple trauma patients in EDs, tools such as the modified early warning score (MEWS) (Bozkurt et al, 2015) have now been widely applied in EDs, particularly in China (Xie et al, 2018). The MEWS has been used for many purposes: to predict in-hospital mortality (Xie et al, 2018), determine hospital admission (Wei et al, 2019), identify critically ill patients (Kruisselbrink et al, 2016), and predict injury severity and need for ICU admission (Salottolo et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

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An improved modified early warning score that incorporates the abdomen score for identifying multiple traumatic injury severity

Jiang

2020

PeerJ

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Background Rapid identification of trauma severity is essential for the timely triage of multiple trauma patients. Tools such as the modified early warning score (MEWS) are used for determining injury severity. Although the conventional MEWS is a good predictor of mortality, its performance assessing injury severity is moderate. This study hypothesized that adding an injury site severity-related score (e.g., abdomen score) may enhance the capability of the MEWS for identifying severe trauma. Method To validate the hypothesis, we propose an improved modified early warning score called MEWS-A, which incorporates an injury site-specific severity-related abdomen score to MEWS. The utility of MEWS and MEWS-A were retrospectively evaluated and compared for identifying trauma severity in adult multiple trauma patients admitted to the emergency department. Results We included 1,230 eligible multiple trauma patients and divided them into minor and severe trauma groups based on the injury severity score. Results of logistic regression and receiver operating characteristic (ROC) curve analyses showed that the MEWS-A had a higher area under the ROC curve (AUC: 0.81 95% CI [0.78–0.83]) than did the MEWS (AUC: 0.77 95% CI [0.74–0.79]), indicating that the MEWS-A is superior to the MEWS in identifying severe trauma. The optimal MEWS-A cut-off score is 4, with a specificity of 0.93 and a sensitivity of 0.54. MEWS-A ≥ 4 can be used as a protocol for decision-making in the emergency department. Conclusions Our study suggests that while the conventional MEWS is sufficient for predicting mortality risk, adding an injury site-specific score (e.g., abdomen score) can enhance its performance in determining injury severity in multiple trauma patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

An improved modified early warning score that incorporates the abdomen score for identifying multiple traumatic injury severity

Jiang

2020

PeerJ

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“…ED-based cardiac arrest was also associated with better neurological outcomes and a shorter length of hospital stay. 3,14 Efforts to identify patients who may progress to ED-based cardiac arrest have traditionally been approached through identification of critically ill patients through triage on arrival to the ED and the identification of patients who unexpectedly deteriorate during their stay in the ED. [15][16][17] Each of these approaches has significant limitations.…”

Section: Epidemiology Of Cardiac Arrest In the Emergency Departmentmentioning

confidence: 99%

“…[35][36][37][38] However, there is an increasing body of evidence that early warning scores may be useful in identifying patients at high risk of in-hospital mortality when used at triage. 14,[39][40][41] Of the numerous early warning scores, the Modified Early Warning Score, National Early Warning Score, and Rapid Emergency Medicine Score are the best studied in the ED. 42 The Modified Early Warning Score has the advantage of being the most studied early warning score in the ED.…”

Section: Aggregate-weighted Scores At Triagementioning

confidence: 99%

Predicting cardiac arrest in the emergency department

2020

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In‐hospital cardiac arrest remains a leading cause of death: roughly 300,000 in‐hospital cardiac arrests occur each year in the United States, ≈10% of which occur in the emergency department. ED‐based cardiac arrest may represent a subset of in‐hospital cardiac arrest with a higher proportion of reversible etiologies and a higher potential for neurologically intact survival. Patients presenting to the ED have become increasingly complex, have a high burden of critical illness, and face crowded departments with thinly stretched resources. As a result, patients in the ED are vulnerable to unrecognized clinical deterioration that may lead to ED‐based cardiac arrest. Efforts to identify patients who may progress to ED‐based cardiac arrest have traditionally been approached through identification of critically ill patients at triage and the identification of patients who unexpectedly deteriorate during their stay in the ED. Interventions to facilitate appropriate triage and resource allocation, as well as earlier identification of patients at risk of deterioration in the ED, could potentially allow for both prevention of cardiac arrest and optimization of outcomes from ED‐based cardiac arrest. This review will discuss the epidemiology of ED‐based cardiac arrest, as well as commonly used approaches to predict ED‐based cardiac arrest and highlight areas that require further research to improve outcomes for this population.

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“…Previous studies have shown that triage levels were related to certain patient outcome variables, such as hospital admission, ICU admission and in-hospital mortality [2,[13][14][15]. Level 1, level 2 and level 3 are defined as urgent patients with a higher proportion of serious adverse events, such as hospital admission and mortality, compared with level 4, which is defined as non-urgent patients [13,16].…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of a four-level Chinese emergency triage for an Emergency Department: A prospective cohort study

Huang¹,

Xie

Xiong³

et al. 2019

Preprint

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Background In order to assign treatment priorities of patients who presenting to emergency departments (ED), various triage scales have been developed around the world. In china, four-tier triage scale was recommended by a national triage guideline that published by the central Chinese government. After that a four-tier triage system, used only in tertiary hospitals in Shenzhen, was published by the Public Hospital Administration of Shenzhen Municipalitfy in August, 2013 (Shenzhen Triage System, SZTS). But the ability in predicting admission and in-hospital mortality with the four-level triage scale for patients presented in emergency department was unclear. This research aimed to assess the prognostic value of the SZTS by examining the association between triage levels and clinical outcomes in adult patients.Methods Patients 18 years of age or older, who were triaged category 1, 2 or 3 in the emergency department (ED) from May 17, 2017 until September 27, 2017, were enrolled. This study evaluated an association between triage level and in-hospital mortality, ICU admission and general ward admission by using multivariable logistic regression analysis. Receiver operating characteristic curves were used to assess the predictive ability of SZTS in determining in-hospital mortality, ICU admission and general ward admission.Results There were 383 patients enrolled in the study. More urgent triage level were significantly related to a higher proportion of in-hospital mortality, ICU admission and general ward admission. The OR for in-hospital mortality (OR 11.6, 95% CI 5.8-22.9, p<0.001), ICU admission (OR 14.4, 95% CI 7.4-27.7, p<0.001) and general ward admission (OR 10.6, 95% CI 1.4-79.2, p=0.022) were greater at triage level 1 compared to triage level 2 and level 3. The AUC for in-hospital mortality, ICU admission and general ward admission prediction of SZTS was 0.838, 0.830 and 0.792, respectively.Conclusions This study suggests that triage levels were associated with general ward admission, ICU admission and in-hospital mortality, and SZTS showed good performance for clinical outcomes prediction.

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Prognostic value of Modified Early Warning Score generated in a Chinese emergency department: a prospective cohort study

Cited by 28 publications

References 26 publications

An improved modified early warning score that incorporates the abdomen score for identifying multiple traumatic injury severity

An improved modified early warning score that incorporates the abdomen score for identifying multiple traumatic injury severity

Predicting cardiac arrest in the emergency department

Prognostic value of a four-level Chinese emergency triage for an Emergency Department: A prospective cohort study

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