The Modified Early Warning Score as a Predictive Tool During Unplanned Surgical Intensive Care Unit Admission

Abstract

Background: The Modified Early Warning Score (MEWS) has been proposed to warn healthcare providers of potentially serious adverse events. We evaluated this scoring system during unplanned escalation of care in hospitalized surgical patients during a 1-year period. Methods: Following institutional review board approval, all consecutive, unplanned surgical admissions into the surgical intensive care unit (SICU) during 2016 were entered into this study. MEWS and patient demographics during bedside evaluation for SICU admission were extracted from electronic medical records. Logistic regression was used to analyze the association of MEWS with the incidence of future mortality. P values were set at <0.01 for statistical significance. Results: In this series of 263 consecutive patients, the incidence of mortality following unplanned escalation of care was 29.3% (confidence interval [CI] 24.1% to 35.0%), ranging from 22% to 57%, with all positive MEWS values. The association of MEWS with future mortality was not statistically significant (P=0.0107). A misclassification rate of 0.29 (CI 0.24 to 0.35) was observed with this association. Conclusion: MEWS provided no clinical benefit as an early warning system, as mortality was elevated throughout the MEWS scale in this clinical setting. The high misclassification rate indicates MEWS does not provide discriminatory support for patients at risk for mortality.

Evaluation of the Overall Accuracy of the Combined Early Warning Scoring Systems in the Prediction of In-Hospital Mortality

“…Many observational studies, as well as pre-intervention and post-intervention evaluation analyses indicating EWS systems, have improved the detection of deterioration clinically [ 20 , 21 ]. Previous studies have shown that MEWS might be useful in reducing mortality in hospital patients [ 22 ]. Thus Modified Early Warning Score (MEWS) will be a protocol to identify patients in hospitals who are at risk of unexpected deterioration catastrophically [ 23 ].…”

A aplicação da escala mews na residência de clínica médica: um relato de experiência / The application of the mews scale in medical clinic residence: an experience report

“…Brazilian Journal of Development, Curitiba, v.7, n.11, p. 106335-106341 nov. 2021 Pontuações baixas na escala (<2), relacionaram-se significativamente com menor probabilidade de eventos graves (MONTENEGRO; MIRANDA, 2019) e necessidade de intervenção imediata. Apesar da extrapolação da escala ser relativamente comum, ela não é melhor, por exemplo, que a qSOFA (quick SOFA) para pacientes sépticos (KHWANNIMIT; BHURAYANONTACHAI; VATTANAVANIT, 2019; KRAMER; SEBAT; LISSAUER, 2019), e há controvérsia sobre ser universalmente aplicável como preditora de admissão em UTI de pacientes cirúrgicos não-eletivos (KUMAR et al, 2020). Do mesmo modo, em um estudo retrospectivo e observacional, obteve-se relação significativa da pontuação na escala MEWS (>6, AUC 0,82) do momento da alta até as 48 horas seguintes, e maior probabilidade de readmissão na UTI (BALSHI et al, 2020).…”

The application value of the Modified Early Warning Score combined with age and injury site scores in the evaluation of injuries in emergency trauma patients

“…As more people have access to road transportation, road traffic accidents have increased, and trauma has become a major problem in emergency medical rescue. The Modified Early Warning Score (MEWS) system has been widely used in many countries because it is quick, easy, and practical (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). Scores are based on 5 items of body temperature, heart rate, consciousness, systolic blood pressure, and respiration.…”