Initial MEWS score to predict ICU admission or transfer of hospitalized patients with COVID-19: A retrospective study

Barnett, William; Radhakrishnan, M.; Macko, John; Hinch, Bryan T.; Altorok, Nezam; Assaly, Ragheb

doi:10.1016/j.jinf.2020.08.047

Cited by 18 publications

(19 citation statements)

References 8 publications

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“…The clinical instability related to the alteration of physiological parameters (blood pressure, heart rate, respiratory rate, body temperature, level of consciousness, oxygen saturation) - Modified Early Warning Score (MEWS) -, is evaluated and allows identification of people at risk of rapid clinical deterioration or death. 11 Considering the above, we suggest the use of rapid ferritin test in addition to clinical evaluation by MEWS in at home management of suspected or confirmed SARS-CoV-2 patients to correctly evaluate the possibility of early corticosteroid treatment and the need of hospitalization to avoid the crowding of emergency rooms.…”

mentioning

confidence: 99%

Use of rapid ferritin test to predict clinical deterioration in at home COVID-19 patients

Gandini¹,

Lubrano

2021

Journal of Infection

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confidence: 99%

Use of rapid ferritin test to predict clinical deterioration in at home COVID-19 patients

Gandini¹,

Lubrano

2021

Journal of Infection

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“…In contrast, in our study, patients hospitalized at a later phase and older age were not linked with ICU transfer, while the evidence of a lower median age in patients died who in the ICU, when compared with those in the RICU suggests that, on the contrary, in our region’s situation of March-May, transfer to the ICU was reserved for younger severe patients, a normal solution in case of shortage of ICU beds. A research letter by Barnett et al focused the attention on the predictive value of baseline factors associated with transfer to the ICU, but, differently from our study, proposed a Modified Early Warning Score for risk assessment, which is based on clinical parameters rather than anamnestic and laboratory findings [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Risk factors for transfer from Respiratory Intermediate Care Unit to Intensive Care Unit in COVID-19

Buonamico

Quaranta

Boniello

et al. 2021

Respiratory Investigation

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Background Patients hospitalized for COVID-19-related pneumonia often need several degrees of ventilatory support, which are performed between Respiratory Intermediate Care Units (RICUs) and Intensive Care Units (ICUs), and which depend on the severity of acute respiratory distress syndrome. There is no firm consensus on transfer predictors from the RICU to the ICU. Methods In this retrospective observational single center study, we evaluated 96 COVID-19 patients referred to the RICU for acute respiratory failure (ARF) according to their transferal to the ICU or their stay at the RICU. We compared demographic data, baseline laboratory profile, and final clinical outcomes to identify early risk factors for transfer. Results The best predictors for transfer to the ICU were elevated C-reactive protein and lymphopenia. The mortality rate was lower in the RICU than in the ICU, where transferred patients who died were mostly younger men and with less comorbidities than those in the RICU. Conclusions Few inflammatory markers can predict the need for transfer from the RICU to the ICU. Due to the ongoing COVID-19 pandemic, we urge better clinical stratification by early and meaningful profiles in patients admitted to the RICU who are at risk of transferal to the ICU.

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“…At the primary care level such as home care of geriatric persons, MEWS was found to be useful for assessment and decision making by nurses and general practitioners. [ 32 ] In the context of the COVID-19 pandemic which threatens to overwhelm healthcare delivery systems at all levels new condition studies have highlighted the use of MEWS score to predict clinical decline in COVID-19 patients prompting timely transfer for ICU care,[ 33 34 ] thus highlighting its applicability for primary care physicians who face large footfall of COVID patients who need triage and transfer. Low daily MEWS scores on the other hand were found to be useful to plan discharge of hospitalized patients.…”

Section: Discussionmentioning

confidence: 99%

Prediction of hospital outcome in emergency medical admissions using modified early warning score (MEWS)

Bhatnagar¹,

Sirohi²,

Dubey³

2021

Journal of Family Medicine and Primary Care

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Objective: To evaluate the applicability of modified early warning (MEWS) Score for prediction of hospital outcomes of medical emergency patients. Design: Prospective hospital based observational study. Setting: A tertiary care level medicine emergency unit in a medical college of North India. Study Population: 300 Patients admitted in medicine emergency. Method: Patients of both sexes of age more than 18 years who were admitted in medical emergency unit at MMIMSR, Ambala were evaluated. Patients who were in cardiac arrest at arrival and those who died within the first 24 hours were excluded and 300 patients were included. Modified Early Warning Score based on physiological parameters was recorded at admission for each patient and monitored over the next 24 hours in the emergency unit. Hospital outcome of the patient in terms of mortality, need for critical care, prolonged stay and uneventful discharge were recorded and correlated with MEWS scores over the first 24 hours in the emergency unit. Receiver Operating Characteristic (ROC) curves was generated to evaluate the utility of MEWS as a tool to predict patient outcome in medical emergency setting. Result: Of the 300 patients studied, the mean age of patients was 49 years, and the majority of the patients were male (61%). A MEWS Score of >5 at 24 hours of admission was associated significantly with in-hospital mortality of patients ( p < 0.0001). The ROC (Receiver Operator Characteristic) curve revealed that in those patients who had a 24 hours MEWS >/= 5, the area under curve was (AUC) = 0.9. (95% CI: 0.95-0.98). Thus, MEWS was an effective predictor of in hospital mortality with sensitivity (78%) and specificity (94%). Conclusion: MEWS, a scoring system based on easily recordable physiological parameters can be used as an effective tool to triage and monitor patients in medical emergency units, to identify patients who are at greater risk of clinical deterioration and need close monitoring or early transfer for critical care or other timely interventions. Thus, application of MEWS in medical emergency units can be a useful tool to improve patient care, ensure optimal utilization of resources and prevent inappropriate discharge or neglect of sick patients.

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Initial MEWS score to predict ICU admission or transfer of hospitalized patients with COVID-19: A retrospective study

Cited by 18 publications

References 8 publications

Use of rapid ferritin test to predict clinical deterioration in at home COVID-19 patients

Use of rapid ferritin test to predict clinical deterioration in at home COVID-19 patients

Risk factors for transfer from Respiratory Intermediate Care Unit to Intensive Care Unit in COVID-19

Prediction of hospital outcome in emergency medical admissions using modified early warning score (MEWS)

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