Abstract
IntroductionThe medical emergency team enables the limitation of patients’ progression to critical illness in the general ward. The early warning scoring system (EWS) is one of the criteria for medical emergency team activation; however, it is not a valid criterion to predict the prognosis of patients with MET activation.AimIn this study, the National Early Warning Score (NEWS) and Rapid Emergency Medicine Score (REMS) was compared with that of the Acute Physiology and Chronic Health Evaluation II (APACHE II) score in predicting the prognosis of patients who had been treated a medical emergency team.Material and MethodsIn this single-centre retrospective cohort study, patients treated by a medical emergency team between April 2013 and March 2019 and the 28-day prognosis of MET-activated patients were assessed using APACHE II, NEWS, and REMS.ResultsOf the 196 patients enrolled, 152 (77.5%) were men, and 44 (22.5%) were women. Their median age was 68 years (interquartile range: 57-76 years). The most common cause of medical emergency team activation was respiratory failure (43.4%). Univariate analysis showed that APACHE II score, NEWS, and REMS were associated with 28-day prognostic mortality. There was no significant difference in the area under the receiver operating characteristic curve of APACHE II (0.76), NEWS (0.67), and REMS (0.70); however, the sensitivity of NEWS (0.70) was superior to that of REMS (0.47).ConclusionNEWS is a more sensitive screening tool like APACHE II than REMS for predicting the prognosis of patients with medical emergency team activation. However, because the accuracy of NEWS was not sufficient compared with that of APACHE II score, it is necessary to develop a screening tool with higher sensitivity and accuracy that can be easily calculated at the bedside in the general ward.
Highlights
The medical emergency team enables the limitation of patients’ progression to critical illness in the general ward
The following variables related to vital signs and physical status, which were calculated for determining the early warning score, were evaluated: systolic and diastolic blood pressure, heart rate, respiratory rate, oxygen saturation determined by pulse oximetry (SpO2), body temperature, mental status evaluated by alertverbal-pain-unresponsive (AVPU) code, and supplemental oxygen therapy
The number of patients in whom the Medical Emergency Team (MET) call was activated during the study period was 211; 15 patients were excluded from this study
Summary
The medical emergency team enables the limitation of patients’ progression to critical illness in the general ward. Aim: In this study, the National Early Warning Score (NEWS) and Rapid Emergency Medicine Score (REMS) was compared with that of the Acute Physiology and Chronic Health Evaluation II (APACHE II) score in predicting the prognosis of patients who had been treated a medical emergency team. In addition to monitoring and tracking patients’ vital signs and physical conditions, Early warning scores are used to identify patients at risk of clinical deterioration [5]. These track and trigger systems play a crucial role in preventing deterioration in hospitalized patients [6]
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