VALIDITY OF MODIFIED EARLY WARNING SCORE SYSTEM IN PREDICTING NEED OF HIGHER LEVEL OF CARE IN ADULT PATIENTS ON GENERAL MEDICAL FLOORS

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SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Modified Early Warning Score (MEWS) has been used in surgical patients to predict need of higher level of care and elective transfers to ICU. This score consists of a score between 0 to 3 for each of the following; respiratory rate, oxygen saturation, heart rate, systolic blood pressure, and consciousness. 0 to 2 for temperature. And 0 to 1 point for urine production. We could not find many studies with large sample size to validate this score in all adults admitted to a tertiary care hospital, thus this score was applied to our patient population. METHODS: We collected data from our hospital for past 6 months and reviewed all rapid response codes called on patients admitted in hospital in that time. All codes like respiratory failure, hypotension, AMS, stroke, tachy-arrhythmias, and cardiac arrest were included. Codes called on visitors were excluded as their MEWS could not be calculated. A total of 500 patients were identified and their MEWS 3 to 6 hours before the code was correlated with them being transferred to ICU during codes. We also calculated Charlson-Comorbidity Index for all patients. RESULTS: We used Logistic regression in 3 different ways to analyze the odds of patients being transferred to ICU based on MEWS. The first was using raw MEWS score and showed 1.8 times increase in the odds of being transferred per 1-unit increase in MEWS score (p-<0.001). The second was splitting MEWS into high (>4) and low (4 or <4) with high MEWS showed 3.2 times increase in the odds of being transferred (p-<0.001). The third was using MEWS split into three categories- each of these odds ratio is using the 0-1 MEWS score as the reference. Patients with MEWS 5+ had 8 times the odds of being transferred to the ICU than people with MEWS 0-1. Overall sensitivity of MEWS >4 to predict need of higher level of care is 17.14% and the specificity is 93.92%. CONCLUSIONS: Patients with a higher MEWS score 3-6 hours before rapid response codes are much more likely to be transferred to the ICU after a code is called. The likelihood of transfer increases as MEWS increases. Charlson-Comorbidity score doesn’t seem to be highly related to MEWS score. However, for some reason in patients with a low MEWS, there were lower odds of being transferred if they have a high Charlson score. CLINICAL IMPLICATIONS: MEWS system can be used to predict need of transfer to higher level of care even before an emergency response team is activated. This will improve patient care outcomes by facilitating early management of clinical conditions that can be managed on floors, or early transfers to ICU. This will also save resources and time of providers who respond to the rapid response alerts. A larger quality improvement study after implementing MEWS in EMR is needed to confirm our findings. DISCLOSURES: No relevant relationships by Fnu Abhishek, source=Web Response No relevant relationships by Syed Hussain, source=Web Response No relevant relationships by BIBHU KOIRALA, source=Web Response No relevant relationships by Urvishkumar Pasrija, source=Web Response No relevant relationships by Syed Arsalan Zaidi, source=Web Response