Abstract
Background: The Modified Early Warning Score (MEWS) has been proposed to warn healthcare providers of potentially serious adverse events. We evaluated this scoring system during unplanned escalation of care in hospitalized surgical patients during a 1-year period.Methods: Following institutional review board approval, all consecutive, unplanned surgical admissions into the surgical intensive care unit (SICU) during 2016 were entered into this study. MEWS and patient demographics during bedside evaluation for SICU admission were extracted from electronic medical records. Logistic regression was used to analyze the association of MEWS with the incidence of future mortality. P values were set at <0.01 for statistical significance.Results: In this series of 263 consecutive patients, the incidence of mortality following unplanned escalation of care was 29.3% (confidence interval [CI] 24.1% to 35.0%), ranging from 22% to 57%, with all positive MEWS values. The association of MEWS with future mortality was not statistically significant (P=0.0107). A misclassification rate of 0.29 (CI 0.24 to 0.35) was observed with this association.Conclusion: MEWS provided no clinical benefit as an early warning system, as mortality was elevated throughout the MEWS scale in this clinical setting. The high misclassification rate indicates MEWS does not provide discriminatory support for patients at risk for mortality.
Highlights
We evaluated this scoring system when used as a component of bedside evaluation during unplanned escalation of care in hospitalized surgical patients following systemwide implementation of the electronic warning system available through the Epic electronic medical record
Logistic regression was used to analyze the association of the bedside Modified Early Warning Score (MEWS) values on the incidence of future mortality
Cuthbertson et al observed that some physiologic measures and MEWS were predictive in surgical patients requiring intensive care units (ICUs) admission, but they acknowledged that their study was limited by missing data and that MEWS required prospective validation.[32]
Summary
The Modified Early Warning Score (MEWS) has been proposed to warn healthcare providers of the potential development of serious adverse events, including unplanned escalation of care.[1,2,3,4,5,6] MEWS is composed of bedside measurements of heart rate, respiratory rate, systolic blood pressure, temperature, and level of consciousness (alert, responsive to voice, responsive to pain, and unresponsive).[6,7] The values of these measurements are scored and ranked, with a clinical response initiated once predetermined threshold scores are exceeded.[6,7] Two studies have suggested that the use of early warning systems, such as MEWS, might be beneficial in reducing mortality in hospitalized patients.[8,9] Pittard developed an outreach monitoring service in 3 surgical wards to assess the benefits of this new service on unplanned admissions to intensive care units (ICUs), length of stay, and mortality rates.[10]. The Modified Early Warning Score (MEWS) has been proposed to warn healthcare providers of potentially serious adverse events. We evaluated this scoring system during unplanned escalation of care in hospitalized surgical patients during a 1-year period. Logistic regression was used to analyze the association of MEWS with the incidence of future mortality. Results: In this series of 263 consecutive patients, the incidence of mortality following unplanned escalation of care was 29.3% (confidence interval [CI] 24.1% to 35.0%), ranging from 22% to 57%, with all positive MEWS values. The association of MEWS with future mortality was not statistically significant (P=0.0107). The high misclassification rate indicates MEWS does not provide discriminatory support for patients at risk for mortality
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
