Modified early warning score predicts the need for hospital admission and inhospital mortality

Burch, Vanessa; Tarr, Gregory P.; Morroni, Chelsea

doi:10.1136/emj.2007.057661

Cited by 188 publications

(211 citation statements)

References 8 publications

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“…30 Although PEWS can identify patients at risk in the ED for ICU admission and, to a lesser extent, identify patients at risk for hospitalization, we do not advise using warning scores as triage tools to prioritize patients. 31 At present, there is no evidence that PEWS are better than conventional triage systems. To prove that PEWS as triage tools are better than conventional triage systems or that PEWS have added value to conventional triage systems, a direct comparison study should be conducted in which patient outcomes and costs are included.…”

Section: Discussionmentioning

confidence: 99%

Validity of Different Pediatric Early Warning Scores in the Emergency Department

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT: Pediatric early warning scores (PEWS) for hospital inpatients have been developed to identify patients at risk for deterioration. Beyond triage, similar systems that identify ill patients and predict requirements for a higher level of care are needed in the emergency department. WHAT THIS STUDY ADDS:The validity of the different PEWS in pediatric emergency care patients has never been evaluated. This study showed that PEWS are capable of detecting children in need of ICU admission. abstract OBJECTIVE: Pediatric early warning scores (PEWS) are being advocated for use in the emergency department (ED). The goal of this study was to compare the validity of different PEWS in a pediatric ED. METHODS:Ten different PEWS were evaluated in a large prospective cohort. We included children aged ,16 years who had presented to the ED of a university hospital in The Netherlands (200922012). The validity of the PEWS for predicting ICU admission or hospitalization was expressed by the area under the receiver operating characteristic (ROC) curves.RESULTS: These PEWS were validated in 17 943 children. Two percent of these children were admitted to the ICU, and 16% were hospitalized. The areas under the ROC curves for predicting ICU admission, ranging from 0.60 (95% confidence interval [CI]: 0.5720.62) to 0.82 (95% CI: 0.79-0.85), were moderate to good. The area under the ROC curves for predicting hospitalization was poor to moderate (range: 0.56 [95% CI: 0.55-0.58] to 0.68 [95% CI: 0.66-0.69]). The sensitivity and specificity derived from the ROC curves ranged widely for both ICU admission (sensitivity: 61.3%-94.4%; specificity: 25.2%-86.7%) and hospital admission (sensitivity: 36.4%-85.7%; specificity: 27.1%-90.5%). None of the PEWS had a high sensitivity as well as a high specificity.CONCLUSIONS: PEWS can be used to detect children presenting to the ED who are in need of an ICU admission. Scoring systems, wherein the parameters are summed to a numeric value, were better able to identify patients at risk than triggering systems, which need 1 positive parameter. Pediatrics 2013;132:e841-e850

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Section: Discussionmentioning

confidence: 99%

Validity of Different Pediatric Early Warning Scores in the Emergency Department

et al. 2013

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“…Several studies have shown that hospital mortality can be predicted on the basis of illness severity scores calculated at the time of admission, either in the emergency department, 18,19 an assessment unit 20,21 or a medical ward. 22 None of these studies looked at whether the average early warning scores varied according to time or day of admission; although such scores are somewhat blunt tools, this analysis may be a useful next step to help our understanding of the variation in mortality we have observed.…”

Section: Patient and Pre-hospital Factorsmentioning

confidence: 99%

Mortality in out-of-hours emergency medical admissions – more than just a weekend effect

Maggs¹,

Mallet²

2010

JRCPE

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Mortality among emergency medical admissions to hospital is higher for admissions at the weekend than on weekdays; this also holds true for certain specific conditions. However, it is unknown whether that effect is limited to weekends. This study calculated mortality in emergency medical admissions for each day of the week, and compared mortality at weekends with weekdays, at nights with days, and in all out-of-hours periods with in-hours in a UK district general hospital. Total mortality was increased for admissions on Mondays, at night, and in all out-of-hours periods; late in-hospital mortality (after seven days) remained increased when the initial admission occurred on Mondays, at night or out of hours. It is likely that illness severity as well as resource and organisational factors are involved.

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“…While clinical condition and acuity primarily influence the likelihood of admission, 3 non-medical factors may also contribute. [4][5][6][7][8][9][10][11][12][13] For the purpose of our study, non-medical refers to all factors, other than a patient's clinical condition, that potentially influence admission decisions.…”

Section: Introductionmentioning

confidence: 99%

Factors Influencing Hospital Admission of Non-critically Ill Patients Presenting to the Emergency Department: a Cross-sectional Study

et al. 2015

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BACKGROUND:Little is known about the factors that influence physicians' admission decisions, especially among lower acuity patients. For the purpose of our study, non-medical refers to all of the factors-other than the patient's clinical condition-that could potentially influence admission decisions. OBJECTIVE: To describe the influence of non-medical factors on physicians' decisions to admit non-critically ill patients presenting to the ED. DESIGN: Cross-sectional study of hospital admissions at a single academic medical center. PARTICIPANTS: Non-critically ill adult patients admitted to the hospital (n=297) and the admitting emergency medicine physicians (n=34). MAIN MEASURES: A patient survey assessed nonmedical factors, including primary care access and utilization. A physician survey assessed clinical and nonmedical factors influencing the decision to admit. Based on physician responses, admissions were characterized as Bstrongly acuity-driven,^Bmoderately acuity-driven,ô r Bweakly acuity-driven.^Among these admission types, we compared length of stay, cost, and readmission within 30 days to the hospital or ED. KEY RESULTS: Based on the admitting physician's assessment, we categorized the motivation for admission as strongly acuity-driven in 185 (62 %) admissions, moderately acuity-driven in 92 (31 %), and weakly acuity-driven in 20 (7 %). Per the physician surveys, 51 % of hospitalizations were strongly or moderately influenced by one or more non-medical factors, including lack of information about baseline conditions (23 %); inadequate access to outpatient specialty care (14 %); need for a diagnostic testing or procedure (12 %); a recent ED visit (11 %); and inadequate access to primary care (10 %). Compared with strongly-acuity driven admissions, admissions that were moderately or weakly acuity-driven were shorter and less costly but were associated with similar rates of ED (35 %) and hospital (27 %) readmission. CONCLUSIONS: Non-medical factors are influential in the admission decisions for many patients presenting to the emergency department. Moderately and weakly acuity-driven admissions may represent a feasible target for alternative care pathways.KEY WORDS: non-medical factors; hospital admission decision; access to care; care transitions; decision making; emergency medicine; health care delivery; medical decision making; severity of illness; socioeconomic factors; utilization.

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Modified early warning score predicts the need for hospital admission and inhospital mortality

Abstract: The MEWS, specifically five selected parameters, may be used as a rapid, simple triage method to identify medical patients in need of hospital admission and those at increased risk of inhospital death.

Cited by 188 publications

References 8 publications

Validity of Different Pediatric Early Warning Scores in the Emergency Department

Validity of Different Pediatric Early Warning Scores in the Emergency Department

Mortality in out-of-hours emergency medical admissions – more than just a weekend effect

Factors Influencing Hospital Admission of Non-critically Ill Patients Presenting to the Emergency Department: a Cross-sectional Study

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