Abstract
PurposeThe frequency, extent, time frame, and implications of changes to the modified early warning score (MEWS) in the 24 hours prior to cardiac arrest are not known. Our aim was to determine the prevalence and trends of the MEWS prior to in-hospital cardiac arrest (IHCA) on a ward, and to evaluate the association between changes in the MEWS and in-hospital mortality.MethodsA total of 501 consecutive adult IHCA patients who were monitored and resuscitated by a medical emergency team on the ward were enrolled in the study between March 2009 and February 2013. The MEWS was calculated at 24 hours (MEWS24), 16 hours (MEWS16), and 8 hours (MEWS8) prior to cardiac arrest.ResultsOut of 380 patients, 268 (70.5%) had a return of spontaneous circulation. The survival rate to hospital discharge was 25.8%. When the MEWS was divided into three risk groups (low: ≤2, intermediate: 3–4, high: ≥5), the distribution of the low-risk MEWS group decreased at each time point before cardiac arrest. However, even 8 hours prior to cardiac arrest, 45.3% of patients were still in the low MEWS group. The MEWS was associated with in-hospital mortality at each time point. However, increasing MEWS value from MEWS24 to MEWS8 was not associated with in-hospital mortality [OR 1.24 (0.77–1.97), p = 0.38].ConclusionsAbout half of patients were still in low MEWS group 8 hours prior to cardiac arrest and an increasing MEWS only occurred in 46.8% of patients, suggesting that monitoring the MEWS alone is not enough to predict cardiac arrest.
Highlights
When the modified early warning score (MEWS) was divided into three risk groups, the distribution of the low-risk MEWS group decreased at each time point before cardiac arrest
The MEWS was associated with in-hospital mortality at each time point
About half of patients were still in low MEWS group 8 hours prior to cardiac arrest and an increasing MEWS only occurred in 46.8% of patients, suggesting that monitoring the MEWS alone is not enough to predict cardiac arrest
Summary
Previous reports have shown that survival to hospital discharge after in-hospital cardiac arrest (IHCA) is approximately 17–24%.[1,2,3] More than 750,000 adult IHCA occur in the United States each year outside of the intensive care setting.[4, 5] Mortality for these patients is significantly higher than that for patients in monitored areas.[4, 6, 7] Up to 80% of these patients will show signs of significant physiological deterioration in the 24 hours prior to cardiac arrest. [8,9,10,11]The medical emergency team concept has evolved to identify clinically deteriorating patients in hospitals in order to prevent cardiac arrest.[12,13,14,15] Hospitals need tools to help them recognize patients at risk of deterioration in order to provide them with the right care at the right time, before cardiac arrest occurs. [21, 22] very little is known about how often, to what extent, and over what time frame the early warning score changes during the 24 hours prior to cardiac arrest, and what the implications of these changes are. Without this information, it is impossible to develop rational treatment protocols. We determined the prevalence and trends of the MEWS during the 24 hours before IHCA on the ward and evaluated the association between a change in the MEWS and in-hospital mortality
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