Modified Early Warning Score Changes Prior to Cardiac Arrest in General Wards

Abstract

PurposeThe frequency, extent, time frame, and implications of changes to the modified early warning score (MEWS) in the 24 hours prior to cardiac arrest are not known. Our aim was to determine the prevalence and trends of the MEWS prior to in-hospital cardiac arrest (IHCA) on a ward, and to evaluate the association between changes in the MEWS and in-hospital mortality.MethodsA total of 501 consecutive adult IHCA patients who were monitored and resuscitated by a medical emergency team on the ward were enrolled in the study between March 2009 and February 2013. The MEWS was calculated at 24 hours (MEWS24), 16 hours (MEWS16), and 8 hours (MEWS8) prior to cardiac arrest.ResultsOut of 380 patients, 268 (70.5%) had a return of spontaneous circulation. The survival rate to hospital discharge was 25.8%. When the MEWS was divided into three risk groups (low: ≤2, intermediate: 3–4, high: ≥5), the distribution of the low-risk MEWS group decreased at each time point before cardiac arrest. However, even 8 hours prior to cardiac arrest, 45.3% of patients were still in the low MEWS group. The MEWS was associated with in-hospital mortality at each time point. However, increasing MEWS value from MEWS24 to MEWS8 was not associated with in-hospital mortality [OR 1.24 (0.77–1.97), p = 0.38].ConclusionsAbout half of patients were still in low MEWS group 8 hours prior to cardiac arrest and an increasing MEWS only occurred in 46.8% of patients, suggesting that monitoring the MEWS alone is not enough to predict cardiac arrest.

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

“…This finding confirms the significant prognostic value of MEWS for length of stay and ICU mortality (Kim et al, 2015).…”

“…Moreover, the MEWS at the last time point (MEWS 5 ) before the ICU admission was significantly higher in the subgroup of patients who died in the ICU than in the group of survivors. This finding confirms the significant prognostic value of MEWS for length of stay and ICU mortality (Kim et al, ).…”

“…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, ).…”

A qualitative exploration of escalation of care in the acute ward setting

“…The National Health Service (NHS) has widespread adoption of EWS systems, but there is little evidence of these supporting a reduction in patient mortality, predicting cardio‐pulmonary arrests, or being consistent in terms of sensitivity or specificity . Despite not showing a significant improvement in reducing mortality, EWS systems that are not followed are linked to adverse sentinel events .…”

Vital signs: Vital for surviving in-hospital cardiac arrest?

“…The observation by Andersen et al that 40.6% of adult IHCA patients in the study database had no recorded vital sign abnormality before arrest resonates with recent findings from South Korea that 45% of patients had a low early warning score (EWS) value 8 3 hours before cardiac arrest and that an increasing EWS value occurred before only 47% of arrests. 13 However, the ability to detect either vita signs abnormalities or associated changes in a timely fashion will be closely related to the frequency of vital signs monitoring, which may be variable or inadequate. 14,15 That vital signs abnormalities are predictive of IHCA outcome is not surprising, given that research has already established the strong relationship between such abnormalities and death, 4,5,18 and that the majority of patients having an IHCA die prior to hospital discharge.…”