Comparative study on the effect of different early warning systems on risk assessment of maternal disease / 中国实用护理杂志

ABSTRACT

Objective:To comprehensively evaluate and compare the early warning system's ability to predict the risk of maternal disease in China, such as the British National Intensive Care Audit and Research Center (ICNARC)-Obstetric Early Warning Score (OEWS) system, the National Maternal Safety Early Warning Standard (MEWC) recommended by the National Coalition for Maternal Safety, the Irish Maternity Early Warning System (IMEWS) proposed in the clinical practice guidelines issued by the head of health services at the Royal Medical College of Ireland.Methods:A total of 872 pregnant women who were admitted to the Women′s Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital were prospectively observed from January 2019 to December 2019. The data during hospitalization were collected to calculate the scores of the three obstetric early warning scoring systems, to compare and evaluate the prediction and identification ability of three early warning systems for critically ill pregnant women.Results:A total of 872 cases were included in this study, of which 167 were critically ill, accounting for 19.2%, and 705 were non-critically ill, accounting for 80.8%. The three obstetric early warning systems (OEWS,MEWC,IMEWS) in critical group scored 4(2, 6),3(0, 6),5(3, 6), and non-critical group scored 1(0, 1), 0(0, 0), 2(0, 3), respectively. The critical group scored significantly higher than the non-critical group ( P<0.001). The AUC of OEWS was 0.961 (95% CI 0.948-0.975, P<0.001) and that of MEWC was 0.803 (95% CI 0.757 - 0.850, P<0.001). The AUC of IMEWS was 0.853 (95% CI 0.817-0.888, P<0.001). No obstetric critical illness occurred when OEWS was 0. The positive likelihood ratio was 8.208 6 when OEWS≥6. Conclusions:Three kinds of early warning systems have good predictive ability for the occurrence of critical obstetric diseases in China. Among the three warning systems, OEWS has better predictive ability than the other two, and has better hierarchical ability. However, due to the differences in population, environment and conditions in different regions, each obstetric medical unit can improve OEWS according to its own conditions and design an obstetric early warning system that meets its own clinical needs.