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Objective:To investigate the value of modified early warning score (MEWS) combined with D-dimer test in the establishment of an acute pancreatitis severity evaluation model.Methods:The clinical data of 357 patients with acute pancreatitis who received treatment in the Second Affiliated Hospital of Anhui Medical University, China between January 2017 and December 2018 were collected for this study. The receiver operating characteristic curve was used to determine the optimal cut-off value of MEWS combined with D-dimer test for predicting non-mild acute pancreatitis. The relationship between MEWS and D-dimer level was analyzed using regression analysis. The area under the curve (AUC) was used to evaluate the ability of each factor to predict the severity of acute pancreatitis. The sensitivity and specificity of the new model to predict non-mild acute pancreatitis were calculated.Results:According to the receiver operating characteristic curve, the AUC of D-dimer, MEWS, and new model were 0.702, 0.628 and 0.734 respectively ( P < 0.05). The AUC of the new model in predicting non-mild acute pancreatitis was significantly higher than that of MEWS and D-dimer test (0.734 > 0.702 > 0.628, Z = 3.20, P < 0.01). Conclusion:The ability of the new model established based on MEWS and D-dimer to predict the severity of acute pancreatitis is stronger than that of each of MEWS and D-dimer. The new model is simple, convenient and more suitable for clinical use.
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Objective:To explore the application effect of the modified early warning score (MEWS) in the allocation of nursing human resources per shift in ICU.Methods:A total of 470 critically ill patients admitted to the ICU of Xuancheng People′s Hospital from January to December 2019 were selected as the experimental group. In each shift, the nursing leader conducted MEWS score for patients in the ward, and assigned nurses at the corresponding level according to the MEWS score. A total of 346 critically ill patients admitted to ICU from January 2018 to December 2018 were selected as the control group. The head nurse assigned nurses daily according to clinical experience.The incidence of accidental events, nurse error events and medical satisfaction were compared between the two groups.Results:The incidences of accident and nurse error in ICU patients in the experimental group were 5.96% (28/470) and 12.13% (57/470), respectively, which were lower than those in the control group [11.56% (40/346) and 17.92% (62/346)]. The difference between the two groups was statistically significant ( χ2=8.19, 5.37, both P<0.05). The satisfaction degree of the experimental group was 98.63 ± 1.06 and 95.96 ± 1.84, respectively, which were higher than that of the control group 92.13 ± 2.17 and 90.43 ± 2.91, and the difference between the two groups was statistically significant ( t=7.62, 8.56, both P<0.05). Conclusions:Using MEWS score to guide the allocation of nursing human resources in each shift of ICU is helpful to reduce the incidence of accidental events in ICU patients and the incidence of nurses′ errors, ensure patient safety and improve medical satisfaction.
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ABSTRACT BACKGROUND: Traditionally peptic ulcer disease was the most common cause of upper gastrointestinal (UGI) bleed but with the changing epidemiology; other etiologies of UGI bleed are emerging. Many scores have been described for predicting outcomes and the need for intervention in UGI bleed but prospective comparison among them is scarce. OBJECTIVE: This study was planned to determine the etiological pattern of UGI bleed and to compare Glasgow Blatchford score, Pre-Endoscopy Rockall score, AIMS65, and Modified Early Warning Score (MEWS) as predictors of outcome. METHODS: In this prospective cohort study 268 patients of UGI bleed were enrolled and followed up for 8 weeks. Glasgow Blatchford score, Endoscopy Rockall score, AIMS65, and MEWS were calculated for each patient, and the area under the receiver operating characteristic (AUC-ROC) curve for each score was compared. RESULTS: The most common etiology for UGI bleed were gastroesophageal varices 150 (63.55%) followed by peptic ulcer disease 29 (12.28%) and mucosal erosive disease 27 (11.44%). Total 38 (15.26%) patients had re-bleed and 71 (28.5%) patients died. Overall, 126 (47%) patients required blood component transfusion, 25 (9.3%) patients required mechanical ventilation and 2 (0.74%) patients required surgical intervention. Glasgow Blatchford score was the best in predicting the need for transfusion (cut off - 10, AUC-ROC= 0.678). Whereas AIMS65 with a score of ≥2 was best in predicting re-bleed (AUC-ROC=0.626) and mortality (AUC-ROC=0.725). CONCLUSION: Gastrointestinal bleed was most commonly of variceal origin at our tertiary referral center in Northern India. AIMS65 was the best & simplest score with a score of ≥2 for predicting re-bleed and mortality.
RESUMO CONTEXTO: Tradicionalmente, a doença úlcera péptica era a causa mais comum de sangramento digestivo alto, mas com a mudança da epidemiologia, outras etiologias do sangramento do trato digestivo alto estão emergindo. Muitas pontuações têm sido descritas para prever resultados e a necessidade de intervenção na hemorragia gastrointestinal superior, mas a comparação prospectiva entre elas é escassa. OBJETIVO: Este estudo foi planeado para determinar o padrão etiológico de pacientes com hemorragia digestiva alta e comparar os escores de Glasgow Blatchford, o Rockall pré-endoscopia, o AIMS65 e o Early Warning modificado (MEWS) como preditores do resultado. MÉTODOS: Neste estudo prospetivo de coorte, 268 pacientes com sangramento digestivo alto foram acompanhados durante 8 semanas. Os escores Glasgow Blatchford, Rockall pré-endoscopia, AIMS65 e MEWS foram calculados para cada paciente, e a área sob a curva (AUC-ROC) para cada pontuação foi comparada. RESULTADOS: A etiologia mais comum para a hemorragia gastrointestinal alta foi varizes gastroesofágicas 150 (63,55%), seguida de úlcera péptica 29 (12,28%) e de doença erosiva de mucosa 27 (11,44%). No total, 38 (15,26%) doentes voltaram a sangrar e 71 (28,5%) doentes morreram. No total, 126 (47%) doentes necessitaram de transfusão de componentes sanguíneos, 25 (9,3%) necessitaram de ventilação mecânica e 2 (0,74%) destes doentes necessitaram de intervenção cirúrgica. O escore de Glasgow Blatchford foi o melhor na previsão da necessidade de transfusão (corte - 10, AUC-ROC =0,678). Enquanto o AIMS65 com uma pontuação de ≥2 foi o melhor na previsão de ressangramento (AUC-ROC =0,626) e mortalidade (AUC-ROC =0,725). CONCLUSÃO: O sangramento gastrointestinal alto mais comum é de origem varicosa em centro de referência terciária. O AIMS65 é o melhor escore simples, com uma pontuação de ≥2 para prever o ressangramento e a mortalidade.
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Objective:To summarize the practical and nursing experience of early activity program for patients after cardiac valve replacement.Methods:Totally 156 patients after cardiac valve replacement from December 2018 to June 2019 were selected. Refer to the seven-steps of cardiac rehabilitation recommended by American Heart Association with daily activity training and Guidelines for cardiovascular rehabilitation and secondary prevention in China, an early activity program based on corrected modified early warning score (MEWS) was offered to the patients, than its effect was evaluated.Results:All the 156 patients were successfully extubated, no adverse events such as pressure ulcers, pipe slip-off and wound dehiscence occurred.Conclusion:On the basis of the correct evaluation of the patient's condition after heart valve replacement, early activities can promote the recovery of cardiopulmonary function and accelerate the recovery of the patient.
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The modified early warning score (MEWS), as a rapid assessment and early warning scoring tool, has been widely used in patients in China, which can help nurses to identify potentially critical patients early, but not in all clinical fields. Through the retrieval of the relevant literature of the clinical application of the MEWS in Wanfang Medical Database from 2011 to 2018, the SWOT analysis was used in this paper [strength (S), weakness (W), opportunities (O) and threats (T)] methods, to systematically analyze the advantages, problems existence, implementation opportunities and challenges in the clinical application of the MEWS in our country. The purpose of this study was to obtain the best cut-off value of MEWS in different diseases and to formulate standard early-warning intervention measures for MEWS, which may provide reference for clinical workers to carry out relevant research.
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Objective To develop an automatic warning software system for MEWS, and apply the MEWS system and SBAR communication mode to the early warning of surgical patients to evaluate its implementation effect. Methods From November 2017 to November 2018, 400 patients in the People′s Hospital of Guigang City, Guangxi, with vital signs and critical illness after surgery were divided into 200 patients in the control group and 200 in the study group according to the random number table. The control group: routinely calculated MEWS scores and reported abnormal values to the doctor to treat the patient′s condition. The research group: Combining MEWS assignment with computer technology, developing MEWS automatic disease warning software system and combining it with SBAR communication mode for early warning of surgical patients′condition, comparing the two groups′disease evaluation time, treatment response speed, communication completion rate and Whether patients and doctors have different job satisfaction with nurses. Results The disease assessment time and treatment response rate of the study group were (45.89±1.528) seconds and (1.22±0.57) minutes, respectively. The control group was (58.01± 5.123) seconds and (3.19 ± 1.56) minutes respectively. The difference between the two groups was significant (t=32.078,-7.899, P<0.01). The communication completion rate of the study group, the patient's job satisfaction to the nurses, and the doctor's job satisfaction to the nurses was 96.0% (192/200), 91.5% (183/200) and 97.0% (194/200) respectively. The rate in the control group was 61.5% (123/200), 79.0% (158/200), and 78.0% (156/200) respectively, the difference between the two groups was significant (χ2=71.126, 12.426, 33.006, P < 0.01). Conclusion The MEWS automatic warning software system and SBAR communication mode can be used to quickly assess the patient′s condition, improve the accuracy of medical communication, alert patients to potential risks and severity of illness, and improve nurses'work efficiency and patient and doctor's satisfaction with nurses'work degree.
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Objective@#To develop an automatic warning software system for MEWS, and apply the MEWS system and SBAR communication mode to the early warning of surgical patients to evaluate its implementation effect.@*Methods@#From November 2017 to November 2018, 400 patients in the People′s Hospital of Guigang City, Guangxi, with vital signs and critical illness after surgery were divided into 200 patients in the control group and 200 in the study group according to the random number table. The control group: routinely calculated MEWS scores and reported abnormal values to the doctor to treat the patient′s condition. The research group: Combining MEWS assignment with computer technology, developing MEWS automatic disease warning software system and combining it with SBAR communication mode for early warning of surgical patients′ condition, comparing the two groups′ disease evaluation time, treatment response speed, communication completion rate and Whether patients and doctors have different job satisfaction with nurses.@*Results@#The disease assessment time and treatment response rate of the study group were (45.89±1.528) seconds and (1.22±0.57) minutes, respectively. The control group was (58.01±5.123) seconds and (3.19±1.56) minutes respectively. The difference between the two groups was significant (t=32.078, -7.899, P<0.01). The communication completion rate of the study group, the patient's job satisfaction to the nurses, and the doctor's job satisfaction to the nurses was 96.0% (192/200), 91.5% (183/200) and 97.0% (194/200) respectively. The rate in the control group was 61.5% (123/200), 79.0% (158/200), and 78.0% (156/200) respectively, the difference between the two groups was significant (χ2=71.126, 12.426, 33.006, P < 0.01).@*Conclusion@#The MEWS automatic warning software system and SBAR communication mode can be used to quickly assess the patient′s condition, improve the accuracy of medical communication, alert patients to potential risks and severity of illness, and improve nurses' work efficiency and patient and doctor's satisfaction with nurses' work degree.
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Objective To compare the Modified Early Warning Score(MEWS),blood glucose value score and the two scores combined with the ability to predict the prognosis of patients with acute complication of diabetes mellitus,and to explore the most suitable assessment tools. Methods 419 patients with acute complica-tions were collected in diabetic mellitus. To put the admission time as the inital observation point,MEWS score, blood glucose value score and MEWS combined with blood glucose value were assessed and compared between the time point of admission and discharge by ROC curve.Results Using death as a prediction index,MEWS score of subjects operating characteristic area under the curve of AUCROC was 0.875 and the optimal cut-off value of was over 4 in the sensitivity of 78.43%,specificity of 85.60%,the positive predictive valueof 43.01% and the negative predictive value of 96.63% independently. The average score of blood glucose area under ROC curve AUCROC was 0.681 and the optimal cut-off value was 2 in the sensitivity of 50.98%,the specificity of 85.33% the positive predictive value of 73.4% and negative predictive value of 67.5% respectively. Two scores combined with area under ROC curve AUCROCwas 0.982,and the optimal cut-off value was over 7 in the sensitivity of 94.12%,the specificity of 95.65%,the positive predictive value of 75% and the negative predictive value of 99.15% individually. Conclusion For predicting the prognosis of patients with acute complications of diabetes,the combined scores are better than the pure MEWS score and blood glucose value.It is worth of clinical application.
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<p><b>PURPOSE</b>Recording vital signs is important in the hospital setting and the quality of this documentation influences clinical decision making. The Modified Early Warning Score (MEWS) uses vital signs to categorise the severity of a patient's physiological derangement and illustrates the clinical impact of vital signs in detecting patient deterioration and making management decisions. This descriptive study measured the quality of vital sign recordings in an acute care trauma setting, and used the MEWS to determine the impact the documentation quality had on the detection of physiological derangements and thus, clinical decision making.</p><p><b>METHODS</b>Vital signs recorded by the nursing staff of all trauma patients in the acute care trauma wards at a regional hospital in South Africa were collected from January 2013 to February 2013. Investigator-measured values taken within 2 hours of the routine observations and baseline patient information were also recorded. A MEWS for each patient was calculated from the routine and investigator-measured observations. Basic descriptive statistics were performed using EXCEL.</p><p><b>RESULTS</b>The details of 181 newly admitted patients were collected. Completion of recordings was 81% for heart rate, 88% for respiratory rate, 98% for blood pressure, 92% for temperature and 41% for GCS. The recorded heart rate was positively correlated with the investigator's measurement (Pearson's correlation coefficient of 0.76); while the respiratory rate did not correlate (Pearson's correlation coefficient of 0.02). In 59% of patients the recorded respiratory rate (RR) was exactly 20 breaths per minute and 27% had a recorded RR of exactly 15. Seven percent of patients had aberrant Glasgow Coma Scale readings above the maximum value of 15. The average MEWS was 2 for both the recorded (MEWS(R)) and investigator (MEWS(I)) vitals, with the range of MEWS(R) 0-7 and MEWS(I) 0-9. Analysis showed 59% of the MEWS(R) underestimated the physiological derangement (scores were lower than the MEWS(I)); 80% of patients had a MEWS(R) requiring 4 hourly checks which was only completed in 2%; 86% of patients had a MEWS(R) of less than three (i.e. not necessitating escalation of care), but 33% of these showed a MEWS(I) greater than three (i.e. actually necessitating escalation of care).</p><p><b>CONCLUSION</b>Documentation of vital signs aids management decisions, indicating the physiological derangement of a patient and dictating treatment. This study showed that there was a poor quality of vital sign recording in this acute care trauma setting, which led to underestimation of patients' physiological derangement and an inability to detect deteriorating patients. The MEWS could be a powerful tool to empower nurses to become involved in the diagnosis and detection of deteriorating patients, as well as providing a framework to communicate the severity of derangement between health workers. However, it requires a number of strategies to improve the quality of vital sign recording, including continuing education, increasing the numbers of competent staff and administrative changes in vital sign charts.</p>
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Objective To compare the quick sequential organ failure assessment score(qSOFA) and modified early warning score (MEWS) for predicting critically ill patients in emergency. Methods According to the inclusion criteria, 499 cases were collected. The scores of qSOFA and MEWS were calculated and compared between survival group and death group, non-ICU group and ICU group. The ROC curve was plotted and to predict capacity of the two scoring systems by comparing AUC. Results Of the 499 patients, 462 (92.6%) survived, 37 (7.4%) died, 358 (71.7%) were non-ICU, and 141 (28.3%)were ICU.The scores of qSOFA and MEWS between survival group and death group, non-ICU group and ICU group had significant differences(P<0.05).The AUC of qSOFA and MEWS was 0.861 and 0.816 by predicting death, and the optimal cutoff values were 1.5 and 4.5.AUC was 0.852 and 0.852 by predicting outcome, and the optimal cutoff values were 1.5 and 4.0. The MEWS and qSOFA score were graded according to MEWS < 4 scores, MEWS ≥ 4 scores and qSOFA < 2 scores, qSOFA ≥ 2 scores respectively.The AUC of the qSOFA grade and MEWS grade were 0.758 and 0.775 by predicting death, 0.716 and 0.767 by predicting outcome. Conclusions qSOFA score can be used to predict critically ill patients in emergency, and the evaluation effect is as same as MEWS score.
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Objective To develop an Modified Early Warning Score (MEWS) table suitable for professional characteristics and to predict the occurrence of complications in the percutaneous coronary intervention (PCI). Methods This is a retrospective study. PCI patients in catheter room of Qingdao International Center Hospital from July to December, 2015 and July to December, 2016 were selected as the research object. The former was set as the control group, and the latter as the experimental group, traditional MEWS and modified MEWS were applied in the two groups respectively. The incidence of complications were compared between two groups. Results The incidence rates of cardiac arrest, drop of blood pressure, arrhythmia, slow blood flow or no complex flow, perforation, interlayer were 0.83％(3/362), 0.55％ (2/362), 0.55％ (2/362), was 0.55％ (2/362), 2.21％ (8/362) , 4.42％ (16/362) , and were 2.51％(9/358), 5.31％(19/358), 8.66％(31/358) , 3.07％(11/358) , 2.51％(9/358) , 2.79％(10/358) in the control group, the differences were statistically significant (χ2= 4.603-5.302, P<0.05). Conclusions The MEWS score of PCI can be used to predict the occurrence of complications in PCI, and for the patients with MEWS score above 5, they should be given medical and nursing intervention in order to reduce the complications in the operation.
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Objective To explore the value of modified early warning score (MEWS) in clinical status assessment and outcome prediction of heat stroke patients.Methods The clinical data of 46 heat stroke patients were collected.According to the severity,the subjects were divided into mild group and severe group;and alternatively,according to the treatment outcomes,the subjects were also divided into survival group and death group.The MEWS at admission was employed for comparison of the differences in severity and outcome of heat stroke between groups.Receiver operating characteristic curve (ROC curve) was used to evaluate the accuracy of MEWS used at admission in assessing severity and predicting outcome of heat stroke patients.Results The results of MEWS calculated at admission in mild and severe heat stroke patients showed significant difference between them (3.00 ± 1.70 vs.6.85 ± 3.03,P =0.004).The area under the ROC curve (AUC) of MEWS got at admission for the diagnosis of severe heat stroke was 0.864 ± 0.056.The results of MEWS obtained at admission in survived and died heat stroke patients were 5.13 ± 2.96 and 9.25 ± 2.05,respectively (P =0.037).The AUC of MEWS used at admission for predicting the death of heat stroke patients was 0.867 ± 0.061.Conclusions The initial MEWS is useful to accurately assess and predict the outcome of heat stroke patients.Heat stroke patients with higher level of MEWS used at admission than 4.5 could be diagnosed as severe heat stroke,and whereas the value of MEWS got at admission higher than 7.5 could be the indicator of the poor prognosis.
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Objective To discuss the feasibility and applicability in prognosis prediction of t he National Early Warning Score (NEWS) for stroke patients in emergency department through comparing NEWS and modified early warning score(MEWS). Methods 1 195 cases of stroke patients for NEWS and MEWS from May 2013 to June 2015 in emergency centerwere chosen, and were tracked prognosis for 30 days, two score prediction ability were compared. Results When took death as prediction index, the area under the ROC curve of NEWS was AZ=0.906, sensitivity was 84.1%,specificity was 86.1%,best truncated point was 4.5 score; The area under the ROC curve of MEWS was AZ=0.846,sensitivity was 80.5%,specificity was 77.9%,best truncated point was 2.5 score, the difference was statistically significant between them (Z=3.324,P<0.05).It showed that NEWS had higher value than MEWS in prognosis prediction for stroke patients in emergency department. Conclusions NEWS score is a good tool to predict stroke patients in emergency department, which has better value than MEWS.
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ObjectiveTo evaluate the value of modified early warning score (MEWS) in predicting mortality of critically ill patients admitted to emergency department.Methods A prospective cohort study was conducted. Clinical data of emergency patients admitted to resuscitation room of Peking Union Medical College Hospital from Feburary 13rd, 2014 to April 20th, 2014 were collected, and their MEWS were calculated based on medical records and their clinical outcomes was followed. Incidence of primary outcome (3-day mortality) and secondary outcome [all deaths and composite outcome of intensive care unit (ICU) transfer, cardio-pulmonary resuscitation, and death] were compared between MEWS positive (MEWS≥5) or negative (MEWS 0-4) patients, and multi-regression logistic analysis was done to look for the impact factors of primary outcome in these patients.Results 176 patients, among them 98 (55.68%) were male, were enrolled in the study. Their mean age was (56.86±21.46) years old. Mean MEWS was 4.30±2.74. There was 74 cases in MEWS positive group, and 102 in negative group. Primary endpoint occurred in 41 patients, and the 3-days mortality in MEWS positive group was significantly higher than that in MEWS negative group [37.84 (28/74) vs. 12.74% (13/102), odds ratio (OR) = 4.167, 95% confidence interval (95%CI) = 1.973-8.804,P< 0.001]. At the meantime, incidence of all death [54.05% (40/74) vs. 17.65% (18/102),OR = 5.490, 95%CI = 2.770-10.883,P< 0.001] and the incidence of ICU transfer, cardio-pulmonary resuscitation and death [64.86% (48/74) vs. 25.49% (26/102),OR = 5.396, 95%CI = 2.809-10.366,P< 0.001] were also significantly higher in MEWS positive group as compared with negative group. Multi-regression logistic showed abnormal mental status (OR = 3.606, 95%CI = 1.541-8.436,P = 0.003) but not MEWS≥5 (OR = 1.672, 95%CI = 0.622-4.494,P = 0.308)was the predictor of 3-day mortality in emergency admitted critically ill patients.Conclusions Although the incidence of severe adverse events is significantly increased in patients with MEWS≥5 compared with those with MEWS 0-4, MEWS≥5 cannot be an efficient predictor for 3-day mortality. Abnormal mental status shows some predictive value for early mortality in critically ill patients seen in emergency department.
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Objective We sought to compare the ability of MEWS score,APACHE Ⅱ score and combination of the two scoring systems to predict the prognosis of patients in emergency medical department.Methods During January to March 2014,640 patients in emergency medical department who met the criteria were set as the research object.The patients admission was the starting point for clinic observation.The relevant data were collected for carrying on the MEWS and APACHE Ⅱ ratings,tracking the patients' prognosis.The corresponding predictors for prognosis of patients such as sensitivity,specificity,positive predictive value,negative predictive value and ROC curve by MEWS score,APACHE Ⅱ score and combination of the two scoring systems were compared.Results The area under the receiver operating characteristic curve was 0.93,0.79 and 0.93 with MEWS score,APACHE Ⅱ score and combination of the two scoring systems.The comparison of either of the two scoring systems showed significant difference.When death was named as the prediction factor,the sensitivity,specificity,positive predictive value and negative predictive value were 76.92％,91.70％,51.02％,97.23％ for MEWS score; 83.08％,62.80％,20.15％ and 97.04％ for APACHE Ⅱ score; 92.31％,86.43％,43.48％ and 97.58％ for combination of the two scoring systems.Conclusions Combination of the MEWS and APACHE Ⅱ scoring systems can be used to predict the prognosis of patients in emergency medical department.It posesses high sensitivity,specificity,positive predictive value and negative predictive value,which indicating a high predictive capability.
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Objective To explore the significance of warning score of potential critical disease in predicting changes in patients with traumatic brain injury. Methods The clinic information of 75 patients with traumatic brain injury who were treated in the People's Hospital of Huangshan Affiliated to Wannan Medical College from Jan. to Dec. 2013 were analyzed retrospectively. The warning score of potential critical disease, modified early warning score( MEWS)and glasgow coma score( GCS)of all patients and the rates of changes in patients were calculated. Results Of 75 patients enrolled,60 were survived and 15 were died. Seventy-five patients were performed 448 times of warning score of potential critical disease,MEWS and GCS. The maximum, minimum of warning score of potential critical disease were 24 and 0,and the median score(P25,P75)was 4(2, 7). The maximum,minimum of MEWS were 24 and 0,and the median score( P25,P75 )was 4( 3,7 ). The maximum,minimum of GCS were 8 and 3,and the median score(P25,P75)was 5(4,7). The area under ROC of warning score of potential critical disease was 0. 76(95%CI =0. 66 -0. 86,P ﹤0. 01),Youden index was 0. 42 when score was taken 5. 5. The area under the ROC of MEWS was 0. 71( 95%CI =0. 61 -0. 81,P﹤0. 01),Youden index was 0. 4 when taken 3. 5 score. The area under the ROC of GCS was 0. 51(95%CI=0. 37-0. 63,P=0. 99),Youden index was 0. 27 when score was taken 4. 5. Conclusion The warning score of potential critical disease is effective to predict changes in conditions of patients with multiple injuries and better than MEWS and GCS.
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BACKGROUND/AIMS: The modified early warning score (MEWS) is used to predict patient intensive care unit (ICU) admission and mortality. Lactate (LA) in the blood lactate (BLA) is measured to evaluate disease severity and treatment efficacy in patients with severe sepsis/septic shock. The usefulness of a combination of MEWS and BLA to predict ICU transfer in severe sepsis/septic shock patients is unclear. We evaluated whether use of a combination of MEWS and BLA enhances prediction of ICU transfer and mortality in hospitalized patients with severe sepsis/septic shock. METHODS: Patients with severe sepsis/septic shock who were screened or contacted by a medical emergency team between January 2012 and August 2012 were enrolled at a university-affiliated hospital with ~2,700 beds, including 28 medical ICU beds. RESULTS: One hundred patients were enrolled and the rate of ICU admittance was 38%. MEWS (7.37 vs. 4.85) and BLA concentration (5 mmol/L vs. 2.19 mmol/L) were significantly higher in patients transferred to ICU than those in patients treated in general wards. The combination of MEWS and BLA was more accurate than MEWS alone in terms of ICU transfer (C-statistics: 0.898 vs. 0.816, p = 0.019). The 28-day mortality rate was 19%. MEWS was the only factor significantly associated with 28-day mortality rate (odds ratio, 1.462; 95% confidence interval, 1.122 to 1.905; p = 0.005). CONCLUSIONS: The combination of MEWS and BLA may enhance prediction of ICU transfer in patients with severe sepsis/septic shock.
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Adult , Aged , Female , Humans , Male , Middle Aged , Biomarkers/blood , Decision Support Techniques , Health Status , Health Status Indicators , Hospital Bed Capacity , Hospital Mortality , Hospitals, University , Intensive Care Units , Lactic Acid/blood , Patient Transfer , Predictive Value of Tests , Prognosis , Retrospective Studies , Risk Assessment , Risk Factors , Sepsis/blood , Shock, Septic/blood , Time FactorsABSTRACT
Objective To investigate the clinical allocation significance of modified early warning score (MEWS) for emergency department patients.Methods MEWS of 1 069 patients in medical emergency department from August 2011 to March 2013 were recorded and analyzed.The admitted differences of MEWS among in intensive care unit(ICU),general wards and emergency transfer observing patients were compared.Results The MEWS of emergency department patients were different.The deaths and ICU patients together as ICU patients,MEWS ≥ 7 scores the proportion of patients admitted to ICU were significantly higher than those of MEWS 3-6 scores and 0-2 scores [37.8％(14/38) vs.2.1％ (6/289) and 0.1％(1/742)](P＜0.01).Conclusion MEWS provides an objective allocation basis for emergency department patients.
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Objective To investigate the application value of modified early warning score (MEWS) for assessment of patients in pre hospital first aid.Methods For patients with MEWS method in 3 478 cases of pre hospital first aid,scored in 0-4,5-9 and ≥ 10 points.Analysis of the relationship between the distribution and severity in patients with different grades,and tracing the fate and the condition of patients after admission.Results In MEWS patients with low 0-4 points was divided into pre hospital first aid,accounted for 69.18％ (2 406/3 478),severe cases accounted for 2.58％ (62/2 406); MEWS 5-9 accounted for 21.54％ (749/3 478),severe patients increased to 37.92％ (284/749); MEWS ≥ 10 points accounted for only 9.29％ (323/3 478),severe patients increased to 87.00％ (281/323).MEWS scores higher ratio in patients with severe more,MEWS 5-9 points,severe patients with MEWS ≥ 10 points 0-4 critical patients proportion (P ＜ 0.01).MEWS 5-9 points,≥ 10 points patients admitted to a specialist ward and intensive care units treatment compared with MEWS 0-4 points patients increased significandy (P ＜ 0.01),the mortality rate was also significandy increased (P ＜ 0.01).Conclusion The MEWS method in pre hospital first aid to early warning of potential in critically ill patients,the higher score,the more serious condition,the higher mortality rate.
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PURPOSE: To assess whether the Modified Early Warning Score (MEWS) predicts the need for intensive care unit (ICU) transfer for patients with severe sepsis or septic shock admitted to general wards. METHODS: A retrospective chart review of 100 general ward patients with severe sepsis or septic shock was implemented. Clinical information and MEWS according to point of time between ICU group and general ward group were reviewed. Data were analyzed using multivariate logistic regression and the area under the receiver operating characteristic curves with SPSS/WIN 18.0 program. RESULTS: Thirty-eight ICU patients and sixty-two general ward patients were included. In multivariate logistic regression, MEWS (odds ratio [OR] 2.02, 95% confidence interval [CI] 1.43-2.85), lactic acid (OR 1.83, 95% CI 1.22-2.73) and diastolic blood pressure (OR 0.89, 95% CI 0.80-1.00) were predictive of ICU transfer. The sensitivity and the specificity of MEWS used with cut-off value of six were 89.5% and 67.7% for ICU transfer. CONCLUSION: MEWS is an effective predictor of ICU transfer. A clinical algorithm could be created to respond to high MEWS and intervene with appropriate changes in clinical management.