1033: AN EVALUATION OF MEWS, NEWS, AND A WIDELY AVAILABLE PROPRIETARY DETERIORATION INDEX

Abstract

Listen

Translate article

Introduction: Hospitalized patients who experience clinical deterioration often display signs of clinical instability in the preceding hours. Many healthcare institutions have adopted processes to proactively identify and intervene on patients likely to experience a deterioration event. The extent to which these processes can intervene in patient care depends on the ability of the health system to accurately detect patients at risk of deterioration. We conducted a retrospective evaluation of three widely adopted early warning scores as a critical first step to ensuring that we can meaningfully intervene in care for patients likely to experience a deterioration event. Methods: We extracted MEWS variables, NEWS variables, and Epic Deterioration Index (EDI) scores for adult (>18 years) inpatient encounters between July 1, 2020 and January 1, 2022 from Vanderbilt University Medical Center’s (VUMC) Epic electronic health record. For each encounter, we calculated MEWS and NEWS scores each time a new variable was recorded. EDI scores are automatically calculated at 15-minute intervals. We defined a clinical deterioration event as an in-hospital cardiac arrest (IHCA), unanticipated transfer to intensive care, or Rapid Response activation. We retrospectively evaluated the performance of each score in predicting a clinical deterioration event at predefined time intervals. Results: Among 68,127 hospitalizations in our study, there were 3,500 (5.1%) that included a deterioration event. The EDI score correctly identified 904 encounters within 24 hours of an event with an area under the receiver operating curve (AUROC) of 0.67, sensitivity of 0.28, specificity of 0.86, and positive predictive value (PPV) of 0.09. Compared to the EDI score, MEWS and NEWS yielded higher sensitivity (0.35 and 0.54) but lower AUROC (0.58 and 0.63), lower specificity (0.78 and 0.65), and lower PPV (0.08 and 0.08). Conclusions: While MEWS and NEWS have been widely evaluated clinical deterioration, the EDI score is a novel proprietary score with less available performance evaluation data. Our analysis compares the EDI against other validated scores to evaluate its use as an early warning score for common clinical deterioration events, and our data supports the use of the EDI score as a mechanism for identify patients at risk for deterioration.