The Modified Early Warning Score: A Useful Marker of Neurological Worsening but Unreliable Predictor of Sepsis in the Neurocritically Ill—A Retrospective Cohort Study

Hester, Jeannette; Youn, Teddy S.; Trifilio, Erin; Robinson, Carol; Babi, Marc-Alain; Ameli, Pouya; Roth, William; Gatica, Sebastián; Pizzi, Michael; Crescioni, Charles; Maciel, Carolina B.; Busl, Katharina M.

doi:10.1097/cce.0000000000000386

Cited by 7 publications

(10 citation statements)

References 23 publications

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“…PEWS was studied in a limited number of pediatric patients in various subgroups. 21,23,24 Limited literature reviews 8,10 were also performed amongst adults, which revealed heterogeneity in the predictive performance of the early warning score across diseases, despite the fact that the current study demonstrated superior performance across all disease subgroups (ROC 0.843 -0.972). Alhmoud et al 10 conducted a large systematic review of early warning scores in adults and revealed that while stroke, cardiac, and renal diseases had the best predictive performance, enhanced accuracy was demonstrated in gastrointestinal, hematologic and respiratory diseases (ROC 0.93 -0.972), despite lowest in neurological disease in this study.…”

Section: Discussionmentioning

confidence: 66%

“…PEWS was studied in a limited number of pediatric patients in various subgroups. 21,23,24 Limited literature reviews 8,10 were also performed amongst adults, which Neurological disease evaluation in children can be challenging because it requires specific critical alarms such as irritability, and training for abnormal neurological signs detection. Modifications to the clinical item and scoring system in the PEWS, as well as intensive training for nurses, may be necessary to increase predictability when using the PEWS.…”

Section: Discussionmentioning

confidence: 99%

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Performance of Modified Pediatric Early Warning Score in General Medical Conditions and Disease Subgroups

Phuaksaman

Sukboonthong

2022

Global Pediatric Health

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Numerous existing Pediatric Early Warning Scores (PEWs) have varying degrees of reliability and validity, which are used in variety diseases of patients. This study is a prospective diagnosis study which involved the pediatric nurse evaluation of patient status using modified Pediatric Early Warning Score (NU-PEWS) until the patient was discharged or transferred to PICU. A total of 824 pediatric patients were admitted, 407 participants were enrolled in this study. The NU-PEWS demonstrated the most accurate cut-off point at greater than 3, with 90.5% sensitivity and 89.1% specificity. The receiver operating characteristic (ROC) indicated positive results in the general medical condition (ROC 0.958), gastrointestinal, respiratory, and hematologic diseases (ROC 0.94-0.97) whereas lowest in neurological disease (ROC 0.843). This study validated that NU-PEWS has good performance in detecting deteriorating patients, and that prediction utilizations are good in almost every subgroup of disease, with the exception of neurological disease.

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Performance of Modified Pediatric Early Warning Score in General Medical Conditions and Disease Subgroups

Phuaksaman

Sukboonthong

2022

Global Pediatric Health

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“…A small Polish study also showed that the MEWS predicted a severe course of SARS-CoV-2 infection [ 47 ]. The MEWS, which appears to be reliable and easy to assess, was found to be useful in predicting neurological worsening in a cohort of more than 7000 neurocritically ill patients with COVID-19 [ 48 ]. However, a recent Indian study showed that not many rating scales, including the MEWS, were found to be useful in identifying patients with COVID-19 who are at risk for clinical worsening [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Neurological Prognostic Factors in Hospitalized Patients with COVID-19

et al. 2022

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We aimed to search whether neurological symptoms or signs (NSS) and the MEWS (Modified Early Warning Score) score were associated with in-hospital mortality or oxygen requirement during the first 14 days of hospitalization in COVID-19 patients recruited at the University Hospital in Krakow, Poland. The detailed clinical questionnaires on twenty NSS were either filled out by patients prospectively or retrospectively assessed by neurologists based on daily medical records. NSS were considered high or low-risk if they were associated with increased or decreased mortality in the univariable analysis. This cohort study included 349 patients with COVID-19 (median age 64, interquartile range (51–77), women 54.72%). The presence of high-risk NSS (decreased level of consciousness, delirium, seizures, and symptoms of stroke or transient ischemic attack) or its combination with the absence of low-risk NSS (headache, dizziness, decreased mood, and fatigue) increased the risk of in-hospital mortality in SARS-CoV-2 infection 3.13 and 7.67-fold, respectively. The presence of low-risk NSS decreased the risk of in-hospital mortality in COVID-19 patients more than 6-fold. Death in patients with SARS-CoV-2 infection, apart from NSS, was predicted by older age, neoplasm, and higher MEWS scores on admission. High-risk NSS or their combination with the absence of low-risk NSS increased the risk of oxygen requirement during hospitalization in COVID-19 patients 4.48 and 1.86-fold, respectively. Independent predictors of oxygen therapy during hospitalization in patients with SARS-CoV-2 infection were also older age, male sex, neoplasm, and higher MEWS score on admission.

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“…This decrease was observed at a time when leukocyte and neutrophil counts are typically elevated. This observation is especially significant since ( 1 ) we analyzed whole blood (rather than PBMC), and ( 2 ) it is therefore likely that a portion of these scant PMN-MDSCs are mature neutrophils, since CD11b + CD15 + CD14 − CD33 +/low CD66b + markers enrich for neutrophils at all maturation stages ( 10 ). High PMN-MDSCs within the first week of sepsis onset have been recently associated with secondary infections, while M-MDSCs appear to be more abundant in sepsis survivors ( 26 ).…”

Section: Discussionmentioning

confidence: 99%

“…This prospective, observational trial was performed on critically ill, adult patients and healthy control volunteers, between 11/2021 and 6/2022. Hospitalized patients were screened for potential sepsis, based on Modified Early Warning Score-Sepsis (MEWS-Sepsis) Recognition Score ( 10 – 12 ), by using a computational algorithm executed twice daily. Two investigators then independently assessed each identified patient for study inclusion according to Sepsis-3 criteria ( 4 ).…”

Section: Methodsmentioning

confidence: 99%

Integrated machine learning approaches for flow cytometric quantification of myeloid-derived suppressor cells in acute sepsis

et al. 2022

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Highly heterogeneous cell populations require multiple flow cytometric markers for appropriate phenotypic characterization. This exponentially increases the complexity of 2D scatter plot analyses and exacerbates human errors due to variations in manual gating of flow data. We describe a semi-automated workflow, based entirely on the Flowjo Graphical User Interface (GUI), that involves the stepwise integration of several, newly available machine learning tools for the analysis of myeloid-derived suppressor cells (MDSCs) in septic and non-septic critical illness. Supervised clustering of flow cytometric data showed correlation with, but significantly different numbers of, MDSCs as compared with the cell numbers obtained by manual gating. Neither quantification method predicted 30-day clinical outcomes in a cohort of 16 critically ill and septic patients and 5 critically ill and non-septic patients. Machine learning identified a significant decrease in the proportion of PMN-MDSC in critically ill and septic patients as compared with healthy controls. There was no difference between the proportion of these MDSCs in septic and non-septic critical illness.

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The Modified Early Warning Score: A Useful Marker of Neurological Worsening but Unreliable Predictor of Sepsis in the Neurocritically Ill—A Retrospective Cohort Study

Abstract: Supplemental Digital Content is available in the text.

Cited by 7 publications

References 23 publications

Performance of Modified Pediatric Early Warning Score in General Medical Conditions and Disease Subgroups

Performance of Modified Pediatric Early Warning Score in General Medical Conditions and Disease Subgroups

Neurological Prognostic Factors in Hospitalized Patients with COVID-19

Integrated machine learning approaches for flow cytometric quantification of myeloid-derived suppressor cells in acute sepsis

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