The comparison of modified early warning score and Glasgow coma scale-age-systolic blood pressure scores in the assessment of nontraumatic critical patients in Emergency Department

Köksal, Özlem; Torun, Gökhan; Ahun, Erhan; Sığırlı, Deniz; Güney, S B; AYDIN, Melek

doi:10.4103/1119-3077.178944

Cited by 15 publications

(18 citation statements)

References 7 publications

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“…When the threshold was 4, the specificity, accuracy and NPV improved at the cost of sensitivity and PPV, and the number of deaths due to missed diagnosis increased from 6 to 16. Hence, this study defined the MEWS cut-off point as 4, which was different from a previous prospective study, whose MEWS cut-off point was defined as 3 15. However, the MEWS cut-off point defined as 3 in this study was different from that of many other studies, whose MEWS cut-off point was defined as 5 or higher 10 20–22.…”

Section: Discussionmentioning

confidence: 58%

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

et al. 2018

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ObjectivesThis study aimed to validate the performance of the Modified Early Warning Score (MEWS) in a Chinese emergency department and to determine the best cut-off value for in-hospital mortality prediction.DesignA prospective, single-centred observational cohort study.SettingThis study was conducted at a tertiary hospital in South China.ParticipantsA total of 383 patients aged 18 years or older who presented to the emergency department from 17 May 2017 through 27 September 2017, triaged as category 1, 2 or 3, were enrolled.OutcomesThe primary outcome was a composite of in-hospital mortality and admission to the intensive care unit. The secondary outcome was using MEWS to predict hospitalised and discharged patients.ResultsA total of 383 patients were included in this study. In-hospital mortality was 13.6% (52/383), and transfer to the intensive care unit was 21.7% (83/383). The area under the receiver operating characteristic curve of MEWS for in-hospital mortality prediction was 0.83 (95% CI 0.786 to 0.881). When predicting in-hospital mortality with the cut-off point defined as 3.5, 158 patients had MEWS >3.5, with a specificity of 66%, a sensitivity of 87%, an accuracy of 69%, a positive predictive value of 28% and a negative predictive value of 97%, respectively.ConclusionOur findings support the use of MEWS for in-hospital mortality prediction in patients who were triaged category 1, 2 or 3 in a Chinese emergency department. The cut-off value for in-hospital mortality prediction defined in this study was different from that seen in many other studies.

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Section: Discussionmentioning

confidence: 58%

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

et al. 2018

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“…These scales are composed of simple parameter systems, multiple parameters, or aggregated weighting systems, the latter being the most reliable. 22,30,31 For this study, four triage methods have been selected that can be performed (at least in a theoretical framework) in the context of MCIs at the prehospital level: SI, 32,33 GAP Score, 34,35 RTS, 36,37 and the NEWS2. 20,38 Table 1 shows the parameters that are evaluated in each scale.…”

Section: Triage System Includedmentioning

confidence: 99%

Accuracy of National Early Warning Score 2 (NEWS2) in Prehospital Triage on In-Hospital Early Mortality: A Multi-Center Observational Prospective Cohort Study

Martin-Rodríguez

López-Izquierdo

Vegas

et al. 2019

Prehosp. Disaster med.

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Introduction:In cases of mass-casualty incidents (MCIs), triage represents a fundamental tool for the management of and assistance to the wounded, which helps discriminate not only the priority of attention, but also the priority of referral to the most suitable center.Hypothesis/Problem:The objective of this study was to evaluate the capacity of different prehospital triage systems based on physiological parameters (Shock Index [SI], Glasgow-Age-Pressure Score [GAP], Revised Trauma Score [RTS], and National Early Warning Score 2 [NEWS2]) to predict early mortality (within 48 hours) from the index event for use in MCIs.Methods:This was a longitudinal prospective observational multi-center study on patients who were attended by Advanced Life Support (ALS) units and transferred to the emergency department (ED) of their reference hospital. Collected were: demographic, physiological, and clinical variables; main diagnosis; and data on early mortality. The main outcome variable was mortality from any cause within 48 hours.Results:From April 1, 2018 through February 28, 2019, a total of 1,288 patients were included in this study. Of these, 262 (20.3%) participants required assistance for trauma and injuries by external agents. Early mortality within the first 48 hours due to any cause affected 69 patients (5.4%). The system with the best predictive capacity was the NEWS2 with an area under the curve (AUC) of 0.891 (95% CI, 0.84-0.94); a sensitivity of 79.7% (95% CI, 68.8-87.5); and a specificity of 84.5% (95% CI, 82.4-86.4) for a cut-off point of nine points, with a positive likelihood ratio of 5.14 (95% CI, 4.31-6.14) and a negative predictive value of 98.7% (95% CI, 97.8-99.2).Conclusion:Prehospital scores of the NEWS2 are easy to obtain and represent a reliable test, which make it an ideal system to help in the initial assessment of high-risk patients, and to determine their level of triage effectively and efficiently. The Prehospital Emergency Medical System (PhEMS) should evaluate the inclusion of the NEWS2 as a triage system, which is especially useful for the second triage (evacuation priority).

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“…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%

“…Specific patient groups studied were patients with COVID-19 [58,61], community acquired infections [33], respiratory distress or dyspnoea [19,36,38], chest pain [19], abdominal pain [19], cancer [48], stroke [46], older ED patients ≥65 years [37,56,59], and trauma patients [52,60,62]. Seven studies purposefully targeted ED patients requiring hospital admission [32,34,45,46,[56][57][58], two studies targeted patients requiring intensive care unit (ICU) admission [55,59], and eight studies targeted patients triaged as having high levels of clinical urgency [35,39,40,42,50,[52][53][54].…”

Section: Study Characteristicsmentioning

confidence: 99%

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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The comparison of modified early warning score and Glasgow coma scale-age-systolic blood pressure scores in the assessment of nontraumatic critical patients in Emergency Department

Abstract: 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.

Cited by 15 publications

References 7 publications

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

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

Accuracy of National Early Warning Score 2 (NEWS2) in Prehospital Triage on In-Hospital Early Mortality: A Multi-Center Observational Prospective Cohort Study

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

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