Clinic study of Modified Early Warning Score (MEWS) in patient's triage in emergency department rescue room

Abstract

Objective To investigate the feasibility of Modified Early Warning Score (MEWS) in evaluating the condition of emergency patients and as a basis for emergency triage. Methods A total of 1 643 patients in the Rescue Room of Emergency Department of Suzhou Integrated Traditional Chinese and Western Medicine Hospital were selected by convenience sampling method from 11th April 2016 to 2nd August 2017. All patients were followed up, and MEWS of patients with different directions were compared. The area under the curve of MEWS and Yoden index were calculated by ROC curve to predict the mortality of patients. Comparing the MEWS of patients in general wards and ICU, the area under the curve of the MEWS was predicted by ROC curve, and the critical value was selected by Yoden index. Results There were 475 cases discharged, 326 cases observed in hospital, 768 hospitalized (101 cases were admitted to ICU, 667 cases were admitted to general wards) and 74 cases died. There was significant difference in MEWS among the four groups (H=236.45, P<0.001) . When the best critical point was 3.5 of MEWS, the area under ROC curve for predicting death was 0.910, 95%CI (0.87-0.95) , and Yoden index was 0.72. There was significant difference in MEWS between patients admitted to general wards and ICU (Z=-9.005, P<0.001) . When picking 2.5 of MEWS as the best critical point, the area under the ROC curve for predicting ICU admission was 0.786, 95%CI (0.73-0.85) , and the Youden index was 0.50. Conclusions The MEWS has clinical significance in predicting the death of emergency patients and assessing the severity of patients. It provides an objective basis for the correct shunt of emergency patients and the correct identification of potentially critically ill patients. Key words: Emergency service, hospital; Prognosis; Modified Early Warning Score; Emergency triage