ARE EARLY WARNING SYSTEMS EFFECTIVE AT PREDICTING CLINICAL DETERIORATION IN PATIENTS WITH COVID-19? A RETROSPECTIVE, SINGLE CENTER STUDY

Abstract

TOPIC: Critical Care TYPE: Original Investigations PURPOSE: Covid-19 affects multiple organs creating a propensity for rapid and fatal deterioration. Previous studies have validated early warning systems as practical bedside tools to identify patients at risk for devastating clinical deterioration. However, few studies have evaluated the efficacy of these models in COVID 19 patients. The Modified Early Warning Score (MEWS) incorporates Respiratory rate, heart rate, systolic blood pressure, temperature, and mentation to tabulate a score. A MEWS cutoff of 5 and above has been proposed as having good sensitivity and specificity at predicting clinical deterioration. This study aims to see if the Modified Early Warning Score system effectively predicts clinical deterioration in the hospitalized COVID 19 population. METHODS: A retrospective electronic medical records review examining consecutive patients admitted to medicine floors with PCR confirmed COVID 19 infection in 2020. We collected patient demographics, Charlson co-morbidity index (CCI) and reviewed if a rapid response and/or transfer to the Intensive care unit (ICU) occurred. MEWS was then calculated at the time of the event, at 6 and 12 hours before the event. Patients who were directly transferred to the ICU from the emergency department were omitted. MDCalc online application was utilized to standardize calculations. RESULTS: 583 electronic medical records were reviewed. A group of 81 (n=81) patients with a median age of 75, 59% white, 59% female, and a median CCI of 5 were identified. Sixty-five patients were transferred to the ICU with a median MEWS of 2, 2, 2 at the transfer time, 6 hours prior, and 12 hours prior, respectively. 16 patients had rapid response codes with a median MEWS of 2, 2, 2 at the time of the code, 6 hours prior and 12 hours prior, respectively. These patients remained on the medical floors. A logistic regression model (OR 0.79 p= 0.25) and Kruskal-Wallis rank-sum test (p= 0.968) failed to show a statistically significant correlation between a MEWS score at any time and transfer to the ICU. CONCLUSIONS: In our patient population MEWS score was not effective in predicting clinical deterioration. The widely available MEWS calculators do not account for oxygen saturation levels or oxygen requirement, which was the most critical factor in determining clinical severity. This, in our opinion, is the limiting factor. We also found that as familiarity with the management of COVID 19 increased and as more resources became available, patients were more likely to remain on the floors rather than being transferred to the ICU. CLINICAL IMPLICATIONS: MEWS score is not valid for detecting clinical deterioration in COVID 19 patients in our study. It falsely underrepresents the severity of illness; therefore, clinicians should use clinical reasoning and objectivity to determine the need for higher level of care. Further studies should focus on determining other predictors of clinical deterioration based on demographic data, symptomology and co-morbidities. DISCLOSURES: No relevant relationships by Abdelrhman Abo-zed, source=Web Response No relevant relationships by Abasin Amanzai, source=Web Response No relevant relationships by Rahul Bollam, source=Web Response No relevant relationships by Leenah Chughtai, source=Web Response No relevant relationships by Bhagat Kondaveeti, source=Web Response No relevant relationships by Jamil Masood, source=Web Response No relevant relationships by Manasi Sejpal, source=Web Response No relevant relationships by Syed Arsalan Zaidi, source=Web Response