A Protocolised Once a Day Modified Early Warning Score (MEWS) Measurement Is an Appropriate Screening Tool for Major Adverse Events in a General Hospital Population

Abstract

BackgroundThe Modified Early Warning Score (MEWS) was developed to timely recognise clinically deteriorating hospitalised patients. However, the ability of the MEWS in predicting serious adverse events (SAEs) in a general hospital population has not been examined prospectively. The aims were to (1) analyse protocol adherence to a MEWS protocol in a real-life setting and (2) to determine the predictive value of protocolised daily MEWS measurement on SAEs: death, cardiac arrests, ICU-admissions and readmissions.MethodsAll adult patients admitted to 6 hospital wards in October and November 2015 were included. MEWS were checked each morning by the research team. For each critical score (MEWS ≥ 3), the clinical staff was inquired about the actions performed. 30-day follow-up for SAEs was performed to compare between patients with and without a critical score.Results1053 patients with 3673 vital parameter measurements were included, 200 (19.0%) had a critical score. The protocol adherence was 89.0%. 18.2% of MEWS were calculated wrongly. Patients with critical scores had significant higher rates of unplanned ICU admissions [7.0% vs 1.3%, p < 0.001], in-hospital mortality [6.0% vs 0.8%, p < 0.001], 30-day readmission rates [18.6% vs 10.8%, p < 0.05], and a longer length of stay [15.65 (SD: 15.7 days) vs 6.09 (SD: 6.9), p < 0.001]. Specificity of MEWS related to composite adverse events was 83% with a negative predicting value of 98.1%.ConclusionsProtocol adherence was high, even though one-third of the critical scores were calculated wrongly. Patients with a MEWS ≥ 3 experienced significantly more adverse events. The negative predictive value of early morning MEWS < 3 was 98.1%, indicating the reliability of this score as a screening tool.

Application of the National Early Warning Score (NEWS) as a stratification tool on admission in an Italian acute medical ward: A perspective study

“…Such finding is common amongst Italian Internal Medicine wards, where about 20% of Internal Medicine hospitalised patients needs more intensive care settings and treatments . We reported a total in‐hospital mortality of 6.2%, which is similar to mortality rate reported in a recent study aimed at determining the predictive value of the protocolised daily MEWS measurement on serious adverse events …”

“…Recently, the ability of the MEWS in predicting serious adverse events in a general hospital population has been examined prospectively. The study indicated the reliability of this score as screening tool …”

The value of the Modified Early Warning Score for unplanned Intensive Care Unit admissions of patients treated in hospital general wards

“…Patients of this study with increased MEWS values prior to unplanned ICU admissions showed increased ICU mortality rate (33.3%), compared with the general mortality rate for the whole ICU (19.7%). This was probably explained by the worse and prolonged physiological derangement of these patients (Subbe et al, ; van Galen, Dijkstra, Ludikhuize, Kramer, & Nanayakkara, ).…”

“…This policy can result in earlier admission to the ICU and reduction of preventable deaths (Cardoso et al, ). Based on the proven prognostic value of the MEWS, researchers have suggested the following cut‐off points as alarms for immediate action: scores ≥ 3 to score ≥ 5, with the higher scoring been associated with significantly more adverse events and increased risk of death (increased specificity) (Kim et al, ; Subbe et al, ; van Galen et al, ).…”

Failure to activate the in-hospital emergency team: causes and outcomes

“…In-hospital emergency systems using more sensitive criteria, including the National Early Warning System (NEWS) and the Modified Early Warning System (MEWS), which use scoring and alert systems based on a set of criteria, including temperature and oxygen saturation, in addition to urinary output, have been reported in the literature. (26,27) …”