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We explored whether modified early warning scores (MEWS) could be used as a tool for triage in pre-hospital settings by comparing MEWS with patient triage on arrival to the emergency department (ED) and prognosis. Adult patients (=20 years old) admitted to EDs between 2016 and 2018 were enrolled from National Emergency Department Information System data in this retrospective study. A total of 8,609,955 participants were included in the analysis. EDMEWS of the dead (4.74 ± 2.51) was higher than that of admitted (1.86 ± 1.72) and discharged patients (1.18 ± 1.15) (p < 0.001). In admitted patients, non-survivors had higher EDMEWS than survivors (p<0.001), and as the level of the Korean Triage and Acquisition Scale was severe, EDMEWS increased (p<0.001) accordingly in these patients. EDMEWS had an adjusted hazard ratio (HR) of 1.164 (95% confidence interval: 1.135±1.194) for mortality (p<0.001). When an EDMEWS of 0 was used as a reference value, the HR increased with an increase in the EDMEWS. As EDMEWS increased from 1 to 7+, HR also increased from 1.115 to 2.508. EDMEWS has a positive correlation with mortality and admission rates in EDs. Moreover, admitted patients with higher EDMEWS had a longer duration of hospitalization and they had a higher mortality rate compared to patients with lower EDMEWS. MEWS can be a useful tool to provide evidence to support decision-making processes involving transportation to the ED and selection of the appropriate level of ED for pre-hospital EMS and longterm care facilities. [ABSTRACT FROM AUTHOR]

bjective: To explore the predictive value of serum albumin (Alb), myoglobin (Mb), modified early warning score (MEWS) and Waterlow score for pressure injury (PI) in intensive care unit (ICU) patients. Methods: 120 patients who were hospitalized in the ICU of the People's Hospital of Xinjiang Uygur Autonomous Region from June 2021 to December 2022 were selected, patients were divided into PI group (43 cases) and non-PI group (77 cases) according to whether PI occurred. The influencing factors of PI in ICU patients were analyzed by multivariate Logistic regression analysis, the predictive value of serum Alb, Mb, MEWS and Waterlow scores for PI in ICU patients was analyzed by receiver operating characteristic (ROC) curve. Results: The age in PI group was higher than that in non-PI group, the proportion of mechanical ventilation, body temperature, Mb, MEWS and Waterlow scores were higher than those in non-PI group, the length of hospital stay was longer than that in non-PI group, and Alb was lower than that in non-PI group (P<0.05). Prolonged hospitalization time and elevated Mb, increased MEWS, and increased Waterlow score were independent risk factors for PI in ICU patients, and elevated Alb was an independent protective factor (P<0.05). The area under the curve of serum Alb, Mb, MEWS and Waterlow score in predicting PI in ICU patients was greater than that predicted by each index (P<0.05). Conclusion: The decrease of serum Alb level and the increase of Mb, MEWS and Waterlow scores are independently correlate with PI in ICU patients, the combination of serum Alb, Mb, MEWS and Waterlow scores has good predictive value for PI in ICU patients. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Upper gastrointestinal bleeding (UGIB) is a life-threatening presentation to the emergency department (ED). In a busy emergency department, emergency department, proper risk stratification is critical to better patients management for patients with variceal or nonvariceal bleeding. This study study was designed to the scoring systems (Modified Early Warning Score (MEW), Pre-endoscopic Rockall (PER), and Glasgow Blatchford Score (GBS) in predicting 15-day mortality, requirement of blood transfusion, probability of rebleeding, and patient outcome within 15-day period in ED. MATERIAL AND METHODS: This study was carried out in with 51 acute UGIB at the emergency department, Department (ED) and department of Medical gastroenterology (MGE) of Narayana Medical College and Hospital, Nellore, India, from February 2020 to June 2022. Clinical The clinical history, presenting signs and symptoms, comorbidities, vitals, laboratory variables, endoscopic diagnosis and treatment history of all patients were recorded and they were followed for 15 days to evaluate rebleeding and its outcome. The chi-square test was applied to qualitative variables. RESULTS: The study enroled 51 patients, of which 82.4% were male, with the majority between 51 and 60 years of age. The majority of cases were presented to the emergency department with haematemesis (60.8%). Non-vasriceal bleeding observed in 94.1% cases. In the 15-day follow- up, 7 patients (7.84%) died and 7 patients (13.7%) rebleed. Totally 26 (50.9%) had a MEWS score of 1, 13 (25.4%) had a score of 2, 9 (17.64%) had a score of >3, and 3 (5.88%) had a score of 0. A PER score of 1 was found in 17 (33.3%), 2 in 4 (7.84%), 3 in 3 (5.88%), 4 in 6 (11.76), 5 in 10 (19.6%) and 6 in 5 (9.80%) patients. 9 (17.6%) cases had a low-risk GBS score of 0-5. Compared to MEWS and GBS, the ROC curve for mortality calculated at 15 days for PERS was 0.96; 95% CI of 0.9 - 1.0, indicating good accuracy. The AUCROC curve for predicting rebleed by PERS score showed area under curve - 0.79, which is also better than the other 2 scoring systems. CONCLUSIONS: PER had a higher negative predictive value (90%) than GBS (80.7%) and MEWS (88.1%) for rebleed measurement. GBS had a higher negative predictive value (96.15%) than PER (52.5%) and MEWS (42.8%) to predict admission of a patient with UGIB. The GBS score >8.5, MEWS score >1.5, and the PER score 4.5 predicted rebleeding. The GBS predicted the need for packed red blood cell transfusions better than the MEWS score and the pre-endoscopic Rockall score. The MEWS score is better at predicting admission and type of bleeding.

The evaluation of acute poisoning is challenging due to varied toxic substances and clinical presentations. The new-Poisoning Mortality Score was recently developed to assess patients with acute poisoning and showed good performance in predicting in-hospital mortality. The objective of this study is to externally validate the performance of the new-Poisoning Mortality Score and to compare it with the Modified Early Warning Score. This retrospective analysis used data from the 2019–2020 Injury Surveillance Cohort, established by the Korea Center for Disease Control and Prevention, to perform external validation of the new-Poisoning Mortality Score. The statistical performances of the new-Poisoning Mortality and Modified Early Warning Scores were assessed and compared in terms of discrimination and calibration. Discrimination analysis involved metrics such as sensitivity, specificity, accuracy, and the area under the receiver operating characteristic curve. For calibration analysis, the Hosmer-Lemeshow goodness-of-fit test was utilized and calibration curves for each score were generated to elucidate the relationship between observed and predicted mortalities. This study analysed 16,570 patients with acute poisoning. Significant differences were observed between survivors and those who died in-hospital, including age, sex, and vital signs. The new-Poisoning Mortality Score showed better performance over the Modified Early Warning Score in predicting in-hospital mortality, in terms of the area under the receiver operating characteristic curve (0.947 versus 0.800), sensitivity (0.863 versus 0.667), specificity (0.912 versus 0.817), and accuracy (0.911 versus 0.814). When evaluated through calibration curves, the new-Poisoning Mortality Score showed better concordance between predicted and observed mortalities. In subgroup analyses, the score system consistently showed strong performance, excelling particularly in substances with high mortality indices and remaining superior in all substances as a group. Our study has helped to validate the new-Poisoning Mortality Score as an effective tool for predicting in-hospital mortality in patients with acute poisoning in the emergency department. The score system demonstrated superior performance over the Modified Early Warning Score in various metrics. Our findings suggest that the new-Poisoning Mortality Score can contribute to the enhancement of clinical decision-making and patient management. [ABSTRACT FROM AUTHOR]

Background: Although the usefulness of the Modified Early Warning Score (MEWS) in predicting clinical deterioration or the need for intensive care unit (ICU) admission has been evaluated in several studies, only few reports have considered the immune status of the patient. Patients receiving chemotherapy for cancer are at risk of sepsis. This study aimed to assess the validity of MEWS in predicting clinical deterioration, ICU admission, and mortality among immunocompromised cancer patients on chemotherapy (CPOC). Methods: This retrospective cohort study was conducted at a tertiary care center in Jeddah, Saudi Arabia. Subjects aged>14 years with positive blood cultures, who were hospitalized between June 2016 and June 2017, were included. MEWS was calculated at different time intervals: before, after, and at the time (0-time) of positive blood culture. Results: Overall, 192 patients were enrolled, including 89 CPOC and 103 immunocompetent individuals (controls). ICU admission rate was significantly lower in the CPOC group than in the control group (21 % vs. 50 %, P

We sought to validate prognostic scores in coronavirus disease 2019 including National Early Warning Score, Modified Early Warning Score, and age-based modifications, and define their performance characteristics.DesignWe analyzed prospectively collected data from the Adaptive COVID-19 Treatment Trial. National Early Warning Score was collected daily during the trial, Modified Early Warning Score was calculated, and age applied to both scores. We assessed prognostic value for the end points of recovery, mechanical ventilation, and death for score at enrollment, average, and slope of score over the first 48 hours.SettingA multisite international inpatient trial.PatientsA total of 1,062 adult nonpregnant inpatients with severe coronavirus disease 2019 pneumonia.InterventionsAdaptive COVID-19 Treatment Trial 1 randomized participants to receive remdesivir or placebo. The prognostic value of predictive scores was evaluated in both groups separately to assess for differential performance in the setting of remdesivir treatment.Measurements and main resultsFor mortality, baseline National Early Warning Score and Modified Early Warning Score were weakly to moderately prognostic (c-index, 0.60-0.68), and improved with addition of age (c-index, 0.66-0.74). For recovery, baseline National Early Warning Score and Modified Early Warning Score demonstrated somewhat better prognostic ability (c-index, 0.65-0.69); however, National Early Warning Score+age and Modified Early Warning Score+age further improved performance (c-index, 0.68-0.71). For deterioration, baseline National Early Warning Score and Modified Early Warning Score were weakly to moderately prognostic (c-index, 0.59-0.69) and improved with addition of age (c-index, 0.63-0.70). All prognostic performance improvements due to addition of age were significant (p < 0.05).ConclusionsIn the Adaptive COVID-19 Treatment Trial 1 cohort, National Early Warning Score and Modified Early Warning Score demonstrated moderate prognostic performance in patients with severe coronavirus disease 2019, with improvement in predictive ability for National Early Warning Score+age and Modified Early Warning Score+age. Area under receiver operating curve for National Early Warning Score and Modified Early Warning Score improved in patients receiving remdesivir versus placebo early in the pandemic for recovery and mortality. Although these scores are simple and readily obtainable in myriad settings, in our data set, they were insufficiently predictive to completely replace clinical judgment in coronavirus disease 2019 and may serve best as an adjunct to triage, disposition, and resourcing decisions.

• Detecting patient deterioration is a challenge for novice and experienced nurses. • The modified early warning score is a simple tool to identify patient decline. • Simulation is effective in teaching students to prevent failure to rescue. The aims of this study were to improve nursing students' ability to recognize, communicate and act upon early warning signs of patient deterioration. The Modified Early Warning Score (MEWS) is a simple tool that nursing students can use to detect early patient deterioration. This pretest-posttest observational study revealed improvements in the MEWS scores, MEWS action algorithm, and adapted SBAR (S-situation, B-background, A-assessment, R-response) use. Nursing students may improve in identifying patient deterioration using the MEWS. [ABSTRACT FROM AUTHOR]

Background: Theophylline is commonly used to control respiratory diseases, especially in developing countries. Theophylline has a narrowed therapeutic index, and its toxicity is associated with morbidity and mortality. Physicians should be aware of the early prediction of the need for intensive care unit admission (ICU) and mechanical ventilation (MV). Aim: This study aimed to assess the power of the Rapid Emergency Medicine Score (REMS), Modified Early Warning Score (MEWS) and Simple Clinical Score (SCS) in predicting the need for ICU admission and/or MV in acute theophylline-poisoned patients. Patients and methods: This cross-sectional study included 58 patients with acute theophylline poisoning who were admitted to our Poison Control Center from the 1st of July 2022 to the 31st of January 2023. The REMS, MEWS and SCS were calculated for all patients on arrival at the hospital. The area under the curve (AUC) and receiver operating characteristics were tested to compare scores. Results: The median values of all studied scores were significantly high among patients who needed MV and/or ICU admission. The AUC of SCS was >0.9, with a sensitivity of 92.9% and specificity of 90.9% for the prediction of ICU admission. Meanwhile, MEWS was an excellent predictor of the need for MV (AUC = 0.996, 95% CI = 0.983–1.000). Conclusions: We recommend using SCS as an early predictor for ICU admission in acute theophylline-poisoned patients. However, MEWS could effectively predict MV requirements in acute theophylline-poisoned patients. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Upper gastrointestinal bleeding (UGIB) is a life-threatening presentation to the emergency department (ED). In a busy emergency department, emergency department, proper risk stratification is critical to better patients management for patients with variceal or nonvariceal bleeding. This study study was designed to the scoring systems (Modified Early Warning Score (MEW), Pre-endoscopic Rockall (PER), and Glasgow Blatchford Score (GBS) in predicting 15-day mortality, requirement of blood transfusion, probability of rebleeding, and patient outcome within 15-day period in ED. MATERIAL AND METHODS: This study was carried out in with 51 acute UGIB at the emergency department, Department (ED) and department of Medical gastroenterology (MGE) of Narayana Medical College and Hospital, Nellore, India, from February 2020 to June 2022. Clinical The clinical history, presenting signs and symptoms, comorbidities, vitals, laboratory variables, endoscopic diagnosis and treatment history of all patients were recorded and they were followed for 15 days to evaluate rebleeding and its outcome. The chi-square test was applied to qualitative variables. RESULTS: The study enroled 51 patients, of which 82.4% were male, with the majority between 51 and 60 years of age. The majority of cases were presented to the emergency department with haematemesis (60.8%). Non-vasriceal bleeding observed in 94.1% cases. In the 15-day follow-up, 7 patients (7.84%) died and 7 patients (13.7%) rebleed. Totally 26 (50.9%) had a MEWS score of 1, 13 (25.4%) had a score of 2, 9 (17.64%) had a score of >3, and 3 (5.88%) had a score of 0. A PER score of 1 was found in 17 (33.3%), 2 in 4 (7.84%), 3 in 3 (5.88%), 4 in 6 (11.76), 5 in 10 (19.6%) and 6 in 5 (9.80%) patients. 9 (17.6%) cases had a low-risk GBS score of 0-5. Compared to MEWS and GBS, the ROC curve for mortality calculated at 15 days for PERS was 0.96; 95% CI of 0.9 - 1.0, indicating good accuracy. The AUCROC curve for predicting rebleed by PERS score showed area under curve - 0.79, which is also better than the other 2 scoring systems. CONCLUSIONS: PER had a higher negative predictive value (90%) than GBS (80.7%) and MEWS (88.1%) for rebleed measurement. GBS had a higher negative predictive value (96.15%) than PER (52.5%) and MEWS (42.8%) to predict admission of a patient with UGIB. The GBS score >8.5, MEWS score >1.5, and the PER score 4.5 predicted rebleeding. The GBS predicted the need for packed red blood cell transfusions better than the MEWS score and the pre-endoscopic Rockall score. The MEWS score is better at predicting admission and type of bleeding. [ABSTRACT FROM AUTHOR]

Copyright of Osmangazi Journal of Medicine / Osmangazi Tip Dergisi is the property of Eskisehir Osmangazi University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective To explore the predictive factors of potential mortality in patients with hepatitis C cirrhosis and sepsis in general wards. Methods　A retrospective analysis was performed on 194 patients with hepatitis C cirrhosis and sepsis diagnosed in the Third People’s Hospital of Kunming City from January 2012 to August 2022. Clinical data such as gender, age, comorbidity, site of infection, history of invasive operation within the last 2 weeks, MEWS score, length of stay, white blood cell/platelet, neutrophil count/lymphocyte count ratio (NLR)，red blood cell and prothrombin time were collected. According to the prognosis, the patients were divided into two groups: death group (n = 13) and survival group (n = 181). The differences of various indicators between the two groups were analyzed and compared, and the influencing factors of death were analyzed. Results A total of 194 patients were included in the analysis, including 151 males (77.8%) and 43 females (22.2%). The average age was 50.6±9.7 years. There were 32 cases (16.5%) with hypertension and 32 cases ( 16.5%） with diabetes. Multivariate Logistic regression analysis showed that HCV infection time (OR = 1.114；95%CI 1.000, 1.241)，MEWS score (OR = 1.761；95%CI 1.210，2.564)，no co-infection (OR = 0.081；95%CI 0.010, 0.667)，neutrophil/lymphocyte ratio (NLR) (OR = 1.084；95%CI 1.021，1.152) was an independent predictor of potential death in patients with hepatitis C cirrhosis and sepsis in the general ward. The sensitivity and specificity of the nomogram model are 92.3%，81.2%，respectively; and the maximum Youden index is 0.735. The result of Hosmer-Lemeshaw test is χ2 = 2.471，P = 0.963 (P > 0.05)，which indicates that the model fits well. ROC curve analysis showed that AUC = 0.916，95%CI 0.856，0.976. Calibration images of the Nomogram was used to verify the diagnostic value of the Nomogram model with an average absolute error of 0.022. The results showed that the actual and predicted values of bacterial infection were in good consistency. Conclusion　Time of HCV infection, MEWS score, unco-infected, and NLR were associated with the risk of death from hepatitis C cirrhosis and sepsis. MEWS combined diagnosis can improve the accuracy of predicting death in patients with hepatitis C cirrhosis and sepsis in general wards. [ABSTRACT FROM AUTHOR]

Although the usefulness of the Modified Early Warning Score (MEWS) in predicting clinical deterioration or the need for intensive care unit (ICU) admission has been evaluated in several studies, only few reports have considered the immune status of the patient. Patients receiving chemotherapy for cancer are at risk of sepsis. This study aimed to assess the validity of MEWS in predicting clinical deterioration, ICU admission, and mortality among immunocompromised cancer patients on chemotherapy (CPOC). This retrospective cohort study was conducted at a tertiary care center in Jeddah, Saudi Arabia. Subjects aged>14 years with positive blood cultures, who were hospitalized between June 2016 and June 2017, were included. MEWS was calculated at different time intervals: before, after, and at the time (0-time) of positive blood culture. Overall, 192 patients were enrolled, including 89 CPOC and 103 immunocompetent individuals (controls). ICU admission rate was significantly lower in the CPOC group than in the control group (21 % vs. 50 %, P <.001). Positive MEWS rate (score ≥4) at 0-time was lower in the CPOC group, but the difference was not significant (39.7 % vs. 60.3 %, P =.129). In the CPOC group, positive MEWS rate (score ≥4) had a sensitivity, specificity, positive predictive value, and negative predictive value of 52.6 %, 70 %, 32.3 %, and 84 %, respectively, which was comparable to that observed in the control group. Furthermore, the receiver operating characteristic curve in the CPOC group showed that MEWS calculated 12–36 h before positive blood culture was a significant predictor of ICU admission. The optimal threshold of MEWS with the best sensitivity and specificity was ≥ 3 for the CPOC group and ≥ 4 for the control group to predict ICU admission. MEWS was a generally poor predictor of mortality. MEWS ≥ 3 calculated 12–36 h before positive blood culture is the best predictor of ICU admission for CPOC. [ABSTRACT FROM AUTHOR]

Introduction: Various diagnostic tools are used to assess the severity of COVID-19 symptoms and the risk of mortality, including laboratory tests and scoring indices such as the Modified Early Warning Score (MEWS). The diagnostic value of inflammatory markers for assessing patients with different severity of COVID-19 symptoms according to the MEWS was evaluated in this study. Materials and Methods: The concentrations of CRP (C-reactive protein) (immunoassay) and IL6 (interleukin 6) (electrochemiluminescence assay) were determined, and CRP/IL6, CRP/L, and LCR ratios were calculated in blood serum samples collected from 374 COVID-19 patients. Results: We demonstrated that CRP, IL6, CRP/IL6, CRP/L, LCR inflammatory markers increase significantly with disease progression assessed based on the MEWS in COVID-19 patients and may be used to differentiating patients with severe and non-severe COVID-19 and to assess the mortality. Conclusion: The diagnostic value of inflammatory markers for assessing the risk of mortality and differentiating between patients with mild and severe COVID-19 was confirmed. [ABSTRACT FROM AUTHOR]

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Background: Chest trauma remained an important type of trauma that carries the risk of morbidity and mortality. The Modified Early Warning Score [MEWS] is a unique score as it is a physiological and simple score which permits improvement in the patient management. The aim of the work: To assess frequency, risk factors of mortality and examine MEWS as a predictor of mortality in patients with isolated chest trauma. Patients and Methods: Prospective analysis of 157 patients presented to emergency department, with isolated chest trauma. Demographic data, MEWS, trauma characteristics, and laboratory data were recorded on admission. The patients received standard management and were followed up until discharge or death. Results: Age of patients ranged from 4 to 79 years. Male constituted 79.6%. About 29% admitted with penetrating chest trauma. About 98% and 82% presented within 24 hours and had unilateral chest trauma. MEWS of them ranged from 0 to 12. There is a significant relationship between mortality and hemoglobin levels, length of hospital stay and MEWS. There is a non-significant relationship between mortality and gender, type of trauma or duration of admission. Unilateral trauma indefinitely protects against mortality. MEWS [≥7] and length of hospital stay [≥4 days] increase mortality risk by 127.3 and 4.7 folds respectively. The cutoff of MEWS for prediction of mortality was ≥ 6.5, with sensitivity of 100%, specificity of 84.9%, [p

BackgroundModified Early Warning Score (MEWS) and National Early Warning Score (NEWS) are widely used in predicting the mortality and intensive care unit (ICU) admission of critically ill patients. This study was conducted to evaluate and compare the prognostic value of NEWS and MEWS for predicting ICU readmission, mortality, and related outcomes in critically ill patients at the time of ICU discharge.MethodsThis multicenter, prospective, observational study was conducted over a year, from April 2019 to March 2020, in the general ICUs of two university-affiliated hospitals in Northwest Iran. MEWS and NEWS were compared based on the patients’ outcomes (including mortality, ICU readmission, time to readmission, discharge type, mechanical ventilation (MV), MV duration, and multiple organ failure after readmission) using the univariable and multivariable binary logistic regression. The receiver operating characteristic (ROC) curve was used to determine the outcome predictability of MEWS and NEWS.ResultsA total of 410 ICU patients were enrolled in this study. According to multivariable logistic regression analysis, both MEWS and NEWS were predictors of ICU readmission, time to readmission, MV status after readmission, MV duration, and multiple organ failure after readmission. The area under the ROC curve (AUC) for predicting mortality was 0.91 (95% CI = 0.88–0.94, P < 0.0001) for the NEWS and 0.88 (95% CI = 0.84–0.91, P < 0.0001) for the MEWS. There was no significant difference between the AUC of the NEWS and the MEWS for predicting mortality (P = 0.082). However, for ICU readmission (0.84 vs. 0.71), time to readmission (0.82 vs. 0.67), MV after readmission (0.83 vs. 0.72), MV duration (0.81 vs. 0.67), and multiple organ failure (0.833 vs. 0.710), the AUCs of MEWS were significantly greater (P < 0.001).ConclusionNational Early Warning Score and MEWS values of >4 demonstrated high sensitivity and specificity in identifying the risk of mortality for the patients’ discharge from ICU. However, we found that the MEWS showed superiority over the NEWS score in predicting other outcomes. Eventually, MEWS could be considered an efficient prediction score for morbidity and mortality of critically ill patients.

Background and Objectives: Physiological scoring systems could potentially aid emergency department (ED) trauma triage, and allowed clinicians to focus on treating the most severe patients first. This study aims to compare Modified Early Warning Score (MEWS), Worthing Physiological Scoring System (WPSS), National Early Warning Score (NEWS), and Rapid Emergency Medicine Score (REMS) in predicting inhospital mortality for multiple trauma patients. Methods: This prospective descriptive study was performed on adult multiple trauma patients referred to the ED of Al-Zahra and Kashani hospitals, Isfahan, Iran during 2019-2020. The primary outcome was inhospital mortality. Receiver operating characteristic (ROC) curve analysis was used to evaluate and compare the performances of four scores. Results: Of the 771 patients included in this study, 738 patients (95.7%) survived after 24 h of admission. The mean age of patients was 38.66 ± 18.67 years, and the majority of patients were male (79.1%). To predict inhospital mortality, the area under the ROC curve (AUC) of REMS, MEWS, NEWS, WPSS, and Injury Severity Score (ISS) were 0.944, 0.889, 0.768, 0.754, and 0.869, respectively. Results showed that REMS was more successful than other scores in predicting in-hospital mortality for multiple trauma patients. AUC of REMS was significantly better than NEWS, WPSS, and ISS in predicting inhospital mortality. Conclusions: The findings of this study reveal that REMS is an excellent predictor of in-hospital mortality and MEWS, NEWS, WPSS, and ISS are good predictors of in-hospital mortality.

The decision of intensive care unit (ICU) admission in acute pesticide poisoning is often challenging, especially in developing countries with limited resources. This study was conducted to compare the efficacy of the Acute Physiology and Chronic Health Evaluation II (APACHE II), Modified Early Warning Score (MEWS), and Poisoning Severity Score (PSS) in predicting ICU admission and mortality of acute pesticide-poisoned patients. This prospective cohort study included all patients admitted to Tanta University Poison Control Center with acute pesticide poisoning from the start of March 2018 to the end of March 2019. Patient data, including demographic and toxicological data, clinical examination, laboratory investigation, and score values, were collected on admission. Out of 337 acute pesticide-poisoned patients, 30.5% were admitted to the ICU, including those poisoned with aluminum phosphide (ALP) (81.5%) and organophosphates (OP) (18.5%). Most non-survivors (86.6%) were ALP poisoning. The PSS had the best discriminatory power in predicting ICU admission and mortality, followed by APACHE II and MEWS. However, no significant difference in predicting ICU admission of OP-poisoned patients was detected between the scores. Additionally, no significant difference in mortality prediction of ALP-poisoned patients was found between the PSS and APACHE II. The PSS, APACHE II, and MEWS are good discriminators for outcome prediction of acute pesticide poisoning on admission. Although the PSS showed the best performance, MEWS was simpler, more feasible, and practicable in predicting ICU admission of OP-poisoned patients. Moreover, the APACHE II has better sensitivity for mortality prediction of ALP-poisoned patients. [ABSTRACT FROM AUTHOR]

Background/Aims Scoring systems play an important role in predicting intensive care unit (ICU) admission or estimating the risk of death in critically ill patients with hematological malignancies. We evaluated the modified early warning score (MEWS) for predicting ICU admissions and in-hospital mortality among at-risk patients with hematological malignancies and developed an optimized MEWS. Methods We retrospectively analyzed derivation cohort patients with hematological malignancies who were managed by a medical emergency team (MET) in the general ward and prospectively validated the data. We compared the traditional MEWS with the MEWS plus SpO2/FiO2 (MEWS_SF) score, which were calculated at the time of MET contact. Results In the derivation cohort, the areas under the receiver-operating characteristic (AUROC) curves were 0.81 for the MEWS (95% confidence interval [CI], 0.76 to 0.87) and 0.87 for the MEWS_SF score (95% CI, 0.87 to 0.92) for predicting ICU admission. The AUROC curves were 0.70 for the MEWS (95% CI, 0.63 to 0.77) and 0.76 for the MEWS_SF score (95% CI, 0.70 to 0.83) for predicting in-hospital mortality. In the validation cohort, the AUROC curves were 0.71 for the MEWS (95% CI, 0.66 to 0.77) and 0.83 for the MEWS_SF score (95% CI, 0.78 to 0.87) for predicting ICU admission. The AUROC curves were 0.64 for the MEWS (95% CI, 0.57 to 0.70) and 0.74 for the MEWS_SF score (95% CI, 0.69 to 0.80) for predicting in-hospital mortality. Conclusions Compared to the traditional MEWS, the MEWS_SF score may be a useful tool that can be used in the general ward to identify deteriorating patients with hematological malignancies.

Objective: To explore the relationship between trends in emergency department modified early warning score (EDMEWS) and the prognosis of elderly patients admitted to the intensive care unit (ICU).Methods: Consecutive non-traumatic elderly ED patients (≥65 years old) admitted to the ICU between July 2018 and June 2019 were enrolled in this retrospective cohort study. The selected patients had at least 2 separate MEWS during their ED stay. Detailed patient information was retrieved initially from the ICU database of our hospital and then crosschecked with electronic medical recording system to confirm the completeness and correctness of the data. Patients who had do-not-resuscitate order and those with incomplete data of EDMEWS, acute physiology and chronic health evaluation (APACHE) II score, or survival information (7-day and 30-day mortality) were excluded. The trends in EDMEWS were determined using the regression line of multiple MEWS measured during ED stay, in which EDMEWS trend progression was defined as the slope of the regression line > zero. The relationship between EDMEWS trend and prognosis was assessed using univariate and multivariate analyses (multiple logistic regression analysis).Results: Of the 1423 selected patients, 499 (35.1%) had worsening 24-h APACHE II score, 110 (7.7%) died within 7 days, and 233 (16.4%) died within 30 days. Factors that were significantly associated with worsening 24-h APACHE II score, 7-day mortality, and 30-day mortality in univariate analysis were selected for inclusion into multiple logistic regression analyses. After adjusting for other covariates, EDMEWS trend progression was significantly associated with 24-h APACHE II score progression, 7-day mortality, and 30-day mortality.Conclusions: EDMEWS trend progression was significantly associated with 24-h APACHE II score progression, 7-day mortality, and 30-day mortality in elderly ED patients admitted to the ICU. EDMEWS is a simple and useful tool for precisely monitoring patients' ongoing condition and predicting prognosis. [ABSTRACT FROM AUTHOR]

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Background Rapid identification of trauma severity is essential for the timely triage of multiple trauma patients. Tools such as the modified early warning score (MEWS) are used for determining injury severity. Although the conventional MEWS is a good predictor of mortality, its performance assessing injury severity is moderate. This study hypothesized that adding an injury site severity-related score (e.g., abdomen score) may enhance the capability of the MEWS for identifying severe trauma. Method To validate the hypothesis, we propose an improved modified early warning score called MEWS-A, which incorporates an injury site-specific severity-related abdomen score to MEWS. The utility of MEWS and MEWS-A were retrospectively evaluated and compared for identifying trauma severity in adult multiple trauma patients admitted to the emergency department. Results We included 1,230 eligible multiple trauma patients and divided them into minor and severe trauma groups based on the injury severity score. Results of logistic regression and receiver operating characteristic (ROC) curve analyses showed that the MEWS-A had a higher area under the ROC curve (AUC: 0.81 95% CI [0.78–0.83]) than did the MEWS (AUC: 0.77 95% CI [0.74–0.79]), indicating that the MEWS-A is superior to the MEWS in identifying severe trauma. The optimal MEWS-A cut-off score is 4, with a specificity of 0.93 and a sensitivity of 0.54. MEWS-A ≥ 4 can be used as a protocol for decision-making in the emergency department. Conclusions Our study suggests that while the conventional MEWS is sufficient for predicting mortality risk, adding an injury site-specific score (e.g., abdomen score) can enhance its performance in determining injury severity in multiple trauma patients.

Background Older adults have been reported to be a population with high-risk of death in the COVID-19 outbreak. Rapid detection of high-risk patients is crucial to reduce mortality in this population. The aim of this study was to evaluate the prognositc accuracy of the Modified Early Warning Score (MEWS) for in-hospital mortality in older adults with COVID-19. Methods A retrospective cohort study was conducted in Wuhan Hankou Hospital in China from 1 January 2020 to 29 February 2020. Receiver operating characteristic (ROC) analysis was used to evaluate the predictive value of MEWS, Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Function Assessment (SOFA), quick Sequential Organ Function Assessment (qSOFA), Pneumonia Severity Index (PSI), Combination of Confusion, Urea, Respiratory Rate, Blood Pressure, and Age ≥65 (CURB-65), and the Systemic Inflammatory Response Syndrome Criteria (SIRS) for in-hospital mortality. Logistic regression models were performed to detect the high-risk older adults with COVID-19. Results Among the 235 patients included in this study, 37 (15.74%) died and 131 (55.74%) were male, with an average age of 70.61 years (SD 8.02). ROC analysis suggested that the capacity of MEWS in predicting in-hospital mortality was as good as the APACHE II, SOFA, PSI and qSOFA (Difference in AUROC: MEWS vs. APACHE II, −0.025 (95% CI [−0.075 to 0.026]); MEWS vs. SOFA, −0.013 (95% CI [−0.049 to 0.024]); MEWS vs. PSI, −0.015 (95% CI [−0.065 to 0.035]); MEWS vs. qSOFA, 0.024 (95% CI [−0.029 to 0.076]), all P > 0.05), but was significantly higher than SIRS and CURB-65 (Difference in AUROC: MEWS vs. SIRS, 0.218 (95% CI [0.156–0.279]); MEWS vs. CURB-65, 0.064 (95% CI [0.002–0.125]), all P < 0.05). Logistic regression models implied that the male patients (≥75 years) had higher risk of death than the other older adults (estimated coefficients: 1.16, P = 0.044). Our analysis further suggests that the cut-off points of the MEWS score for the male patients (≥75 years) subpopulation and the other elderly patients should be 2.5 and 3.5, respectively. Conclusions MEWS is an efficient tool for rapid assessment of elderly COVID-19 patients. MEWS has promising performance in predicting in-hospital mortality and identifying the high-risk group in elderly patients with COVID-19.

The effectiveness of treatment and prognosis of patients with type 1 myocardial infarction are highly correlated with time of diagnosis. This study aimed to develop a type 1 MI rapid screening scale (T1MIrs scale) suitable for emergency pre-diagnosis. A total of 1928 patients who underwent coronary angiography were enrolled. Multivariate regression analysis was used to identify the independent risk factors of type 1 MI. And the T1MIrs scale was developed and evaluated according to the multivariate regression result. The incidence of type 1 MI was 23.3% in the population with suspected acute coronary syndrome. After 5 adjusting for relevant factors, MEWS score (OR = 1.809, 95%CI 1.623–2.016, P <.001), typical symptoms (OR = 9.826, 95%CI 7.379–13.084, P <.001), male (OR = 2.184, 95%CI 1.602–2.979, P <.001), age (OR = 1.021, 95%CI 1.009–1.033, P =.001), history of diabetes (OR = 2.174, 95%CI 1.594–2.963, P <.001) and current smoker (OR = 2.498, 95%CI 1.550–4.026, P <.001) were the independent risk factors for type 1 MI. The T1MIrs scale is established based on risk factors, with a range of 0–8 points. The incidence of type 1 MI is ascending with the scale (0.3% vs. 3.7% vs. 14.3% vs. 34.9% vs. 57% vs. 76.4% vs. 84.2% vs. 87.5% vs. 100%, P for trend <0.001). Type 1 MI is common in patients with suspected acute coronary syndrome in emergency department. The T1MIrs scale could act as a rapid pre-examination triage of suspected population in emergency department, which is meaningful to screen out type 1 MI patients as soon as possible. • The incidence of type 1 MI in patients with suspected acute coronary syndrome was high (almost close to one in four). • Type 1 myocardial infarction rapid screening scale was first created based on the symptoms of patients and MEWS scores. • Type 1 myocardial infarction rapid screening scale could act as a pre-examination triage in emergency department. [ABSTRACT FROM AUTHOR]

In hospitalized patients malnutrition is a risk factor for adverse clinical outcomes. The Nutritional Risk Screening 2002 (NRS-2002) represents a quick and simple tool to identify malnutrition risk in this population. No study tested the predictive power of NRS-2002 on mortality adjusting for confounders related to patient's complexity, thus considering conditions such as functional status, illness-related severity and inflammation. The aim of this study was to explore the independent prognostic power and the relative weight of NRS-2002 screening tool to predict inhospital and post-discharge (up to 1 year) mortality, adjusting for variables representing the non-disease specific multidimensional complexity of patients admitted to Internal Medicine wards. Retrospective observational study including 5698 consecutive patients acutely admitted to an Internal Medicine Department. Logistic regression models were run to test the predictive power of the NRS-2002 on patient mortality at different time intervals, adjusted for age, sex, Charlson comorbidity index, Glasgow Prognostic Score (GPS), BUN/creatinine ratio, Modified Early Warning Score (MEWS), and Norton index. The performance of the logistic models in predicting mortality was measured through the c -statistic. The different time of death between patients scored upon admission as NRS-2002 < 3 or ≥3 was evaluated through crude Kaplan-Meier curves and multivariate Cox proportional hazard analysis. Patients classified at high malnutrition risk (NRS-2002 ≥ 3) showed a higher and earlier mortality (Log-rank test: p < 0.001) compared to subjects in the NRS-2002 "low-risk" group. NRS-2002 ≥ 3 was an independent significant (p < 0.01) predictor of mortality in logistic regression at every time interval. Among the considered covariates, Charlson index, GPS and Norton scale showed a steadily higher OR than NRS-2002 in predicting both early and late mortality. The multivariate models demonstrated a very good discrimination for hospital and mid-term (up to 90 days) mortality. Being classified at risk for malnutrition (NRS-2002 ≥ 3) on admission independently increased the risk of one-year death (HR = 1.431; 95% CI: 1.277–1.603; p < 0.001) compared to the patients who were scored at low malnutrition risk. Malnutrition risk identified upon hospital admission by NRS-2002 independently contributes to early and late mortality in a population including a majority of elderly. However, risk of malnutrition has to be considered according to other factors related to comorbidities, functional status, illness severity and inflammation which reciprocally interact, concurring at worsening patient's outcome. [ABSTRACT FROM AUTHOR]

This study aimed to develop a new model on the basis of the National Early Warning Score to predict intensive care unit admission and the mortality of patients with acute pancreatitis. Patients diagnosed with acute pancreatitis in the emergency department were enrolled. The values of the National Early Warning Score, Modified Early Warning Score, and Bedside Index of Severity in Acute Pancreatitis in predicting intensive care unit admission and mortality of patients with acute pancreatitis were evaluated. A total of 379 patients with acute pancreatitis were enrolled; 77 patients (20.3%) were admitted to the intensive care unit and 14 (3.7%) died. The National Early Warning Score and calcium level were identified as independent risk factors of intensive care unit admission. Serum calcium exhibited a moderate correlation with National Early Warning Score (r = -0.46; P < 0.001), Modified Early Warning Score (r = -0.37; P < 0.001), and Bedside Index of Severity in Acute Pancreatitis (r = -0.39; P < 0.001). A new model called National Early Warning Score-calcium was developed by combining National Early Warning Score and calcium blood test result, which had larger areas under the curve for predicting intensive care unit admission and mortality than the other 3 scoring systems. A new model developed by combining National Early Warning Score and calcium exhibited better value in predicting the prognosis of acute pancreatitis than the models involving National Early Warning Score, Modified Early Warning Score, and Bedside Index of Severity in Acute Pancreatitis alone. [ABSTRACT FROM AUTHOR]

This study compares the effect of the modified early warning score (MEWS) versus a new early warning system (Niguarda MEWS) for detecting instability and criticality in hospital medical departments. A retrospective observational study was conducted in the Internal Medicine ward of Niguarda Ca’ Granda Hospital in Milan between November 2013 and October 2014. MEWS and Niguarda-MEWS were gathered using: systolic blood pressure, respiratory frequency, heart rate, temperature, level of consciousness, oxygen saturation, creatinine level, hematocrit level and age. In order to determine if the patient was critical or not the MEWS criticality cut-off value chosen was 3, while in the Niguarda MEWS it was 6. The primary outcome was the correlation between the critical level of the two scores and in-hospital mortality. The secondary endpoint was the correlation between a specific disease and the two scores. In the study, 471 patients were included, using both the MEWS and the Niguarda MEWS score at admittance: 33.4% of patients turned out to be critically ill using the former, 40.98% when using the latter. Therefore, the specificity of scores was 70% for MEWS and 73% for Niguarda MEWS, the sensitivity 58% for MEWS and 63% for Niguarda MEWS, Niguarda MEWS area under the curve (AUC): 0.736, MEWS AUC: 0.670. For the secondary outcome, the new score is higher for genitourinary and respiratory diseases. Niguarda-MEWS could be an optimal tool to detect criticality and instability in order to address the patient to the right level of care.

The aim of this study is to evaluate the usefulness of the pre-hospital National Early Warning Score (pNEWS) and the pre-hospital Modified Early Warning Score (pMEWS) for predicting admission and in-hospital mortality in elderly patients presenting to the emergency department (ED). We also compare the value of the pNEWS with that of the ED NEWS (eNEWS) and ED MEWS (eMEWS) for predicting admission and in-hospital mortality. This retrospective, single-centre observational study was carried out in the ED of Jikei University Kashiwa Hospital, in Chiba, Japan, from 1st April 2017 to 31st March 2018. All patients aged 65 years or older were included in this study. The pNEWS/eNEWS were derived from seven common physiological vital signs: respiratory rate, peripheral oxygen saturation, the presence of inhaled oxygen parameters, body temperature, systolic blood pressure, pulse rate and Alert, responds to Voice, responds to Pain, Unresponsive (AVPU) score, whereas the pMEWS/eMEWS were derived from six common physiological vital signs: respiratory rate, peripheral oxygen saturation, body temperature, systolic blood pressure, pulse rate and AVPU score. Discrimination was assessed by plotting the receiver operating characteristic (ROC) curve and calculating the area under the ROC curve (AUC). The median pNEWS, pMEWS, eNEWS and eMEWS were significantly higher at admission than at discharge (p < 0.001). The median pNEWS, pMEWS, eNEWS and eMEWS of non-survivors were significantly higher than those of the survivors (p < 0.001). The AUC for predicting admission was 0.559 for the pNEWS and 0.547 for the pMEWS. There was no significant difference between the AUCs of the pNEWS and the pMEWS for predicting admission (p = 0.102). The AUCs for predicting in-hospital mortality were 0.678 for the pNEWS and 0.652 for the pMEWS. There was no significant difference between the AUCs of the pNEWS and the pMEWS for predicting in-hospital mortality (p = 0.081). The AUC for predicting admission was 0.628 for the eNEWS and 0.591 for the eMEWS. The AUC of the eNEWS was significantly greater than that of the eMEWS for predicting admission (p < 0.001). The AUC for predicting in-hospital mortality was 0.789 for the eNEWS and 0.720 for the eMEWS. The AUC of the eNEWS was significantly greater than that of the eMEWS for predicting in-hospital mortality (p < 0.001). For admission and in-hospital mortality, the AUC of the eNEWS was significantly greater than that of the pNEWS (p < 0.001, p < 0.001), and the AUC of the eMEWS was significantly greater than that of the pMEWS (p < 0.01, p < 0.05). Our single-centre study has demonstrated the low utility of the pNEWS and the pMEWS as predictors of admission and in-hospital mortality in elderly patients, whereas the eNEWS and the eMEWS predicted admission and in-hospital mortality more accurately. Evidence from multicentre studies is needed before introducing pre-hospital versions of risk-scoring systems.

Modified Early Warning Score (MEWS) is a useful scoring system that detects physiological changes in identifying adult medical surgical patients at risk for deterioration and death. Although it is a good predictor of deterioration and mortality in hospitalized patients, the performance of MEWS in the ED and specifically in head trauma patients is still untested. The purpose of this study was to assess the performance of MEWS in predicting the outcome of head trauma patients in ED. We conducted a retrospective observational study at RSUD dr. Soedono Madiun, East Java Province, Indonesia. The sample using the medical record of patients with moderate-severe head trauma adjusted to the inclusion and exclusion criteria and used purposive sampling technique as many as 181 respondents. Multivariate analysis of ordinal logistic regression to determine the MEWS parameters that most influenced the outcome of head trauma patients, while the ability to predict outcomes was assessed using The Area Under Receiver Operating Characteristic (AUROC) analysis. The ordinal logistic regression results show that AVPU parameters show an Odd Ratio (OR) value of =2.89, meaning that the poor AVPU parameter measurement results have a risk of obtaining a death outcome of 2.89 greater than the outcome of moderate disability, severe disability, vegetative state persistence. The AUC MEWS value to predict the outcome of head trauma patients was 0.777 (95% CI; 0710-0,836) so that based on the AUC value the level of accuracy of MEWS’s scoring predictions was in good classification. In conclusion, MEWS’s ability shows good performance in predicting the outcome of head trauma patients. [ABSTRACT FROM AUTHOR]

Assessment of early clinical warning signs and appropriate response can prevent serious adverse events in hospitalized patients. The Modified Early Warning Score (MEWS) is an applicable early warning sign system that can be used to predict serious adverse events. This study aimed to evaluate the predictive capacity of the MEWS to identify patients in an Iranian hospital who are at risk of developing serious adverse events. In this prognostic study, 381 adult patients from the emergency department who were admitted to an inpatient hospital unit of an Iranian hospital from May 2018 to October 2018 were included. The MEWS tool was completed for each patient at the time of admission and then daily for a period of up to 30 continuous days after admission or until the development of a serious adverse event. Receiver operating characteristic, specificity, sensitivity, positive predictive values, and negative predictive values were calculated. In this study, a MEWS of ≥3 on admission was associated with an increased likelihood of developing serious adverse events within 30 days of admission with the area under the curve of 0.82 (95% confidence interval [CI]: 0.77–0.85), sensitivity of 82.81% (95% CI: 71.3–91.1), specificity of 75.39% (95% CI: 70.3–80), positive predictive value of 40.5% (95% CI: 35.2–45.9), and negative predictive value of 95.6% (95% CI: 92.7–97.4). A MEWS ≥3 on admission can predict the occurrence of serious averse events in patients admitted to an Iranian hospital for 30 continuous days. [ABSTRACT FROM AUTHOR]

Typically acute deterioration in sick people is preceded by subtle changes in the physiological parameters such as pulse and blood pressure. The Modified Early Warning Score is a scoring system developed to assist hospital staff in gauging these physiological changes and identifying patients in need of urgent medical care to avoid catastrophic deterioration. This work discusses the design and implementation of an equivalent warning system that utilizes fuzzy logic techniques to categorize patients' status. The system is implemented and tested in Rashid Centre for Diabetes and Research in UAE. Results are compared with those obtained using the Modified Early Warning System that is currently used in practice. We demonstrate that the implemented system provides reliable results that are in agreement with the current Modified Early Warning Score system, with the added benefit of a scoring scheme that provides a better insight into the status or medical condition of each patient. [ABSTRACT FROM AUTHOR]

Objective: To assess utility and accuracy of general observation modified early warning score charts; and compare sensitivity and specificity of single‐ and multiple‐parameter‐based trigger scores on patient outcomes in the ED. Methods: Retrospective cohort clinical audit of all adult Modified Early Warning Score charts in the ED of a mixed tertiary hospital over 4 weeks. Data extracted included recorded parameters required to calculate Modified Early Warning Score and evidence of response. Results: Of 5901 ED presentations, medical records system identified 2482 Modified Early Warning Score; 347 were missing or blank. Of 2135 Modified Early Warning Score charts, 19.5% contained a calculation error, 51.9% had one or more missing parameters and 36.6% did not have usual/target systolic blood pressure recorded; with 25.1% (95% confidence interval [CI] 23.3–27.0) charts correctly completed. Four hundred and forty‐three had a single‐abnormal parameter of which chart review showed 96.6% (94.5–97.3) were identified as abnormal by nurses with 25.7% (21.9–30.0); only 5.6% (3.9–8.2) had evidence of recognition by medical staff. Modified Early Warning Score sensitivity and specificity for ward admission was 14.7% and 96.1%, respectively. Modelling using the dataset of a single‐abnormal parameter suggested sensitivity and specificity of 31.6% and 85.8%, respectively. Conclusions: This study highlights serious deficiencies in documentation of abnormal parameters and emergency response. It has also shown poor accuracy of both single‐ and multiple‐parameter‐based trigger scores in predicting patient outcomes within the ED. However, single‐parameter‐based trigger scores are twice as sensitive as total Modified Early Warning Score for admission and reduces documentation error by 23%. [ABSTRACT FROM AUTHOR]

BACKGROUND: The modified early warning score (MEWS) is used to detect early clinical deterioration and to escalate care as needed. Respiratory therapists (RTs) usually do not use the MEWS even when it is implemented as a default in the electronic health record system. This study explored whether the technology acceptance model could predict the intentions of RTs to use the MEWS. METHODS: A validated survey that uses a pretest/posttest design was used to determine the effect of an educational intervention (lecture and interactive small group session) on RTs' MEWS knowledge. We also measured key determinants of the intention by RTs to use the MEWS based on the constructs of the technology acceptance model. The survey was distributed to 75 RTs employed at a Midwestern academic medical center. RESULTS: There was a 61% survey response rate. Statistical analysis of the survey data demonstrated that the educational intervention increased the MEWS knowledge score from 2.0 before education to 4.0 after education (P < .001). Moreover, there was a statistically significant increase in the behavioral intention score, from 3.0 before education to 4.0 after education (P < .001). Partial least squares structural equation modeling revealed that MEWS knowledge influenced perceived ease of use, which influenced attitude, which influenced behavioral intention. CONCLUSIONS: Numerous studies have demonstrated that a change in behavioral intention is a good predictor of change in behavior. The increase in the RTs' knowledge, attitude, and behavioral intention scores after MEWS education indicated that these RTs may be more inclined to use the MEWS if they were educated about its clinical relevance and if their attitude toward using it were favorable. Analysis of the study results also indicated that the technology acceptance model could serve as a framework to guide respiratory care managers in the development of strategies to successfully implement new systems or processes that are intended to be used by RTs. [ABSTRACT FROM AUTHOR]

The modified early warning score (MEWS) is used to detect clinical deterioration of hospitalized patients. We aimed to investigate the predictive value of MEWS and derived quick Sequential Organ Failure Assessment (qSOFA) scores for intensive care unit admission in patients with a hematologic malignancy admitted to the ward. Retrospective, observational study in two Dutch university hospitals. Data from adult patients with a hematologic malignancy, admitted to the ward over a 2-year period, were extracted from electronic patient files. Intensive care admission. We included 395 patients with 736 hospital admissions; 2% (n = 15) of admissions resulted in admission to the intensive care unit. A higher MEWS (OR 1.5; 95 %CI 1.3–1.80) and qSOFA (OR 4.4; 95 %CI 2.1–9.3) were associated with admission. Using restricted cubic splines, a rise in the probability of admission for a MEWS ≥ 6 was observed. The AUC of MEWS for predicting admission was 0.830, the AUC of qSOFA was 0.752. MEWS was indicative for intensive care unit admission two days before admission. MEWS was a sensitive predictor of ICU admission in patients with a hematologic malignancy, superior to qSOFA. Future studies should confirm cut-off values and identify potential additional characteristics, to further enhance identification of critically ill hemato-oncology patients. The Modified Early Warning Score (MEWS) can be used as a tool for healthcare providers to monitor clinical deterioration and predict the need for intensive care unit admission in patients with a hematologic malignancy. Yet, consistent application and potential reevaluation of current thresholds is crucial. This will enable bedside nurses to more effectively identify patients needing adjunctive care, facilitating timely interventions and improved outcome. [ABSTRACT FROM AUTHOR]

The definition of the role of hospitals and communities in terms of the response to patients’ health care needs is essential in the Lombardy region health-care reform development (LR. 23/2015). The stratification of patients according to clinical severity and care complexity for adequate clinical health care, is achieved by delineating care settings, staff standards, required technical equipment and crucial aspects of clinical pathways. An observational and retrospective study at Manerbio Hospital Internal Medicine Unit (IMU) was carried out to define: i) characteristics of IMU patients; ii) role of IMU physician in management of poly-pathological patients; iii) alternative organizational models. After a Literature review, clinical severity was defined by modifying early warning score, complexity and co-morbidities by cumulative illness rating scale (CIRS) and by intensity of care through care intensity index (IIA). All medical records of patients admitted in the first quarter of 2016 were analyzed. A total of 393 medical records were examined: 199 M/194 F, median age 81 years. Critical patients (requiring continuous monitoring using advanced equipment): 27% of the sample (10% with intensive care transfer criteria). Co-morbidity: between 5 and 6 active diseases for most of the sample; 53% with CIRS between 7 and 12. Elevated care intensity (IIA) was found in 46% of the sample, remaining constant throughout hospital stay. Medium stay: 9.35 days. 27% of IMU patients needs subintensive care. About a quarter of patients has unresolved social problems contributing to acute presentations in the emergency room. Agreement on appropriate links between hospital and community care structures is advisable to reduce hospital stay, adequately responding to patients’ needs.

The Modified Early Warning Score (MEWS) reflects the physiological changes of cardiac arrest and has been used in identifying patient deterioration. Physiological reserve capacity is an important outcome predictor, but is seldom reported due to recording limitations in cardiac arrest patients. The aim of the study was to evaluate whether periarrest MEWS could be a further prognostic factor in in-hospital cardiac arrest. Methods: This was a retrospective cohort study of nontrauma adult patients who had experienced in-hospital cardiac arrest during emergency department stays at an urban, 2600-bed tertiary medical center in Taiwan from February 2011 to July 2013. Data regarding patients' characteristics, Charlson Comorbidity Score, MEWS score before events, mode of arrest, and outcome details were extracted following the Utstein guidelines for uniform reporting of cardiac arrest. Results: During the 30-month period, 234 patients suffered in-hospital cardiac arrest during emergency department stays, and 99 patients with periarrest MEWS were included in the final analysis. The MEWS at triage did not differ significantly between survival-to-discharge and mortality groups (3.42 ± 2.2 vs. 4.02 ± 2.65, p = 0.811). Periarrest MEWS was lower in the survival-to-discharge group (4.41 ± 2.28 vs. 5.82 ± 2.84, p = 0.053). In multivariate logistic regression analysis, periarrest MEWS was an independent predictors for survival to discharge. A rise in periarrest MEWS reduced the chance of survival to discharge by 0.77-fold (95% confidence interval: 0.60–0.97, p = 0.028). Conclusion: The simplest MEWS system not only can be used as a prevention measure, but the periarrest MEWS could also be considered as an independent predictor of mortality after in-hospital cardiac arrest.

Aim: The aim of the study was to explore the assessment value of the modified early warning score (MEWS) for the long-term prognosis of older patients with chronic heart failure (CHF)., Methods: A total of 180 CHF patients, treated from January 2016 to January 2018, were divided into a grade I group ( n = 28), a grade II group ( n = 37), a grade III group ( n = 68) and a grade IV group ( n = 47) according to the New York Heart Association (NYHA) functional classification. The MEWS was compared on admission and discharge. Based on the clinical outcomes during follow up, the patients were divided into a non-survival group ( n = 48) and a survival group ( n = 132). Their general clinical data and the MEWS were compared. The predictive values of the MEWS, troponin I (cTnI) and B-type natriuretic (BNP) peptide for long-term prognosis were assessed using receiver operator characteristic (ROC) curves., Results: The MEWS on patient discharge was significantly lower than that on admission, and it increased with increasing NYHA grade ( p < 0.05). The MEWS in the non-survival group was significantly higher than that in the survival group. Different clinical outcomes were positively correlated with NYHA grade, MEWS, six-minute walking distance and left ventricular ejection fraction ( r = 0.368, r = 0.471, r = 0.387, r = 0.423, p < 0.05), and negatively correlated with cTnI and BNP ( r = -0.411, r = -0.425). The area under the ROC curve of the MEWS was 0.852, indicating higher accuracy. The optimal cut-off value, sensitivity and specificity of the MEWS for determining prognosis were 5.6, 0.854 and 0.797 points, respectively., Conclusion: The MEWS rose with increasing NYHA grade and reflected the severity of CHF in older patients, which has higher predictive value for long-term prognosis.

Background: For critical patients in resuscitation room, the early prediction of potential risk and rapid evaluation of disease progression would help physicians with timely treatment, leading to improved outcome. In this study, it focused on the application of National Early Warning Score on predicting prognosis and conditions of patients in resuscitation room. The National Early Warning Score was compared with the Modified Early Warning Score) and the Acute Physiology and Chronic Health Evaluation II. Objectives: To assess the significance of NEWS for predicting prognosis and evaluating conditions of patients in resuscitation rooms. Methods: A total of 621 consecutive cases from resuscitation room of Xuanwu Hospital, Capital Medical University were included during June 2015 to January 2016. All cases were prospectively evaluated with Modified Early Warning Score, National Early Warning Score, and Acute Physiology and Chronic Health Evaluation II and then followed up for 28 days. For the prognosis prediction, the cases were divided into death group and survival group. The Modified Early Warning Score, National Early Warning Score, and Acute Physiology and Chronic Health Evaluation II results of the two groups were compared. In addition, receiver operating characteristic curves were plotted. The areas under the receiver operating characteristic curves were calculated for assessing and predicting intensive care unit admission and 28-day mortality. Results: For the prognosis prediction, in death group, the National Early Warning Score (9.50 ± 3.08), Modified Early Warning Score (4.87 ± 2.49), and Acute Physiology and Chronic Health Evaluation II score (23.29 ± 5.31) were significantly higher than National Early Warning Score (5.29 ± 3.13), Modified Early Warning Score (3.02 ± 1.93), and Acute Physiology and Chronic Health Evaluation II score (13.22 ± 6.39) in survival group (p < 0.01). For the disease progression evaluation, the areas under the receiver operating characteristic curves of National Early Warning Score, Modified Early Warning Score, and Acute Physiology and Chronic Health Evaluation II were 0.760, 0.729, and 0.817 (p < 0.05), respectively, for predicting intensive care unit admission; they were 0.827, 0.723, and 0.883, respectively, for predicting 28-day mortality. The comparison of the three systems was significant (p < 0.05). Conclusion: The performance of National Early Warning Score for predicting intensive care unit admission and 28-day mortality was inferior than Acute Physiology and Chronic Health Evaluation II but superior than Modified Early Warning Score. It was able to rapidly predict prognosis and evaluate disease progression of critical patients in resuscitation room. [ABSTRACT FROM AUTHOR]

The definition of the role of hospitals and communities in terms of the response to patients' health care needs is essential in the Lombardy region health-care reform development (LR. 23/2015). The stratification of patients according to clinical severity and care complexity for adequate clinical health care, is achieved by delineating care settings, staff standards, required technical equipment and crucial aspects of clinical pathways. An observational and retrospective study at Manerbio Hospital Internal Medicine Unit (IMU) was carried out to define: i) characteristics of IMU patients; ii) role of IMU physician in management of poly-pathological patients; iii) alternative organizational models. After a Literature review, clinical severity was defined by modifying early warning score, complexity and co-morbidities by cumulative illness rating scale (CIRS) and by intensity of care through care intensity index (IIA). All medical records of patients admitted in the first quarter of 2016 were analyzed. A total of 393 medical records were examined: 199 M/194 F, median age 81 years. Critical patients (requiring continuous monitoring using advanced equipment): 27% of the sample (10% with intensive care transfer criteria). Co-morbidity: between 5 and 6 active diseases for most of the sample; 53% with CIRS between 7 and 12. Elevated care intensity (IIA) was found in 46% of the sample, remaining constant throughout hospital stay. Medium stay: 9.35 days. 27% of IMU patients needs subintensive care. About a quarter of patients has unresolved social problems contributing to acute presentations in the emergency room. Agreement on appropriate links between hospital and community care structures is advisable to reduce hospital stay, adequately responding to patients' needs. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To determine the value of the Modified Early Warning Score (MEWS) for general ward patients and its potential use as an alarm tool for ward nurses. Methods: A combined prospective‐retrospective observational study was conducted with 153 patients in a university hospital (2013‐2014). All patients were admitted to the intensive care unit (ICU) from general wards. Parameters retrospectively studied were 5 MEWS values at 4 hourly intervals, up to 20 hours before ICU admission. Parameters prospectively studied were ICU length of stay, ICU mortality, and mortality after ICU discharge. Results: Most frequent severe adverse events were acute respiratory failure (39.9%) and septic shock (20.3%). Modified Early Warning Score increased gradually during the last 20 hours, and most patients remained in the wards, above a cut‐off point ≥7 recorded at 4 hours before admission. Significant associations between latest MEWS score and ICU mortality and ICU length of stay were found. MEWS score≥ 7 hours before admission was highly associated with increased ICU and hospital mortality. Conclusion: Patient deterioration in general wards can result in severe adverse events. Modified Early Warning Score is a strong predictor of outcome and may be used as a monitoring tool for potentially avoidable deaths and unplanned admissions to ICU. [ABSTRACT FROM AUTHOR]

Background: Modified early warning score has been validated in many uses in the emergency department. We propose that the modified early warning score performs well in predicting the need of lifesaving interventions in the emergency department, as a predictor of patients who are critically ill. Objective: The study aims to evaluate the use of modified early warning score in sorting out critically ill patients in the emergency department. Methods: The patients’ demographic data and first vital signs (blood pressure, heart rate, temperature, respiratory rate, and level of consciousness) were collected prospectively. Individual modified early warning score was calculated. The outcome was a patient received one or more lifesaving interventions toward the end of stay in emergency department. Multivariate logistic regression analysis was utilized to assess the association between modified early warning score and other potential predictors with outcome. Results: There are a total of 259 patients enrolled into the study. The optimal modified early warning score in predicting lifesaving intervention was ≥4 with a sensitivity of 95% and specificity of 81%. Modified early warning score ≥4 (odds ratio = 96.97, 95% confidence interval = 11.82–795.23, p < 0.001) was found to significantly increase the risk of receiving lifesaving intervention in the emergency department. Conclusion: Modified early warning score is found to be a good predictor for patients in need of lifesaving intervention in the emergency department. [ABSTRACT FROM AUTHOR]

Purpose: Recording vital signs is important in the hospital setting and the quality of this documentation influences clinical decision making. The Modified Early Warning Score (MEWS) uses vital signs to categorise the severity of a patient's physiological derangement and illustrates the clinical impact of vital signs in detecting patient deterioration and making management decisions. This descriptive study measured the quality of vital sign recordings in an acute care trauma setting, and used the MEWS to determine the impact the documentation quality had on the detection of physiological derangements and thus, clinical decision making.Methods: Vital signs recorded by the nursing staff of all trauma patients in the acute care trauma wards at a regional hospital in South Africa were collected from January 2013 to February 2013. Investigator-measured values taken within 2 hours of the routine observations and baseline patient information were also recorded. A MEWS for each patient was calculated from the routine and investigator-measured observations. Basic descriptive statistics were performed using EXCEL.Results: The details of 181 newly admitted patients were collected. Completion of recordings was 81% for heart rate, 88% for respiratory rate, 98% for blood pressure, 92% for temperature and 41% for GCS. The recorded heart rate was positively correlated with the investigator's measurement (Pearson's correlation coefficient of 0.76); while the respiratory rate did not correlate (Pearson's correlation coefficient of 0.02). In 59% of patients the recorded respiratory rate (RR) was exactly 20 breaths per minute and 27% had a recorded RR of exactly 15. Seven percent of patients had aberrant Glasgow Coma Scale readings above the maximum value of 15. The average MEWS was 2 for both the recorded (MEWS(R)) and investigator (MEWS(I)) vitals, with the range of MEWS(R) 0-7 and MEWS(I) 0-9. Analysis showed 59% of the MEWS(R) underestimated the physiological derangement (scores were lower than the MEWS(I)); 80% of patients had a MEWS(R) requiring 4 hourly checks which was only completed in 2%; 86% of patients had a MEWS(R) of less than three (i.e. not necessitating escalation of care), but 33% of these showed a MEWS(I) greater than three (i.e. actually necessitating escalation of care).Conclusion: Documentation of vital signs aids management decisions, indicating the physiological derangement of a patient and dictating treatment. This study showed that there was a poor quality of vital sign recording in this acute care trauma setting, which led to underestimation of patients' physiological derangement and an inability to detect deteriorating patients. The MEWS could be a powerful tool to empower nurses to become involved in the diagnosis and detection of deteriorating patients, as well as providing a framework to communicate the severity of derangement between health workers. However, it requires a number of strategies to improve the quality of vital sign recording, including continuing education, increasing the numbers of competent staff and administrative changes in vital sign charts. [ABSTRACT FROM AUTHOR]

Aims and objectives To develop and validate a modified Situation-Background-Assessment-Recommendation communication tool incorporating components of the Cape Town modified early warning score vital signs chart for reporting early signs of clinical deterioration. Background Reporting early signs of physiological and clinical deterioration could prevent 'failure to rescue' or unexpected intensive care admission, cardiac arrest or death. A structured communication tool incorporating physiological and clinical parameters allows nurses to provide pertinent information about a deteriorating patient in a logical order. Design Mixed methods instrument development and validation. Methods We used a sequential three-phase method: cognitive interviews, content validation and inter-rater reliability testing to validate a self-designed communication tool. Participants were purposively selected expert nurses and doctors in government sector hospitals in Cape Town. Results Cognitive interviews with five experts prompted most changes to the communication tool: 15/42 (35.71%) items were modified. Content validation of a revised tool was high by a predetermined ≥70% of 18 experts: 4/49 (8.2%) items were modified. Inter-rater reliability testing by two nurses indicated substantial to full agreement (Cohen's kappa .61-1) on 37/45 (82%) items. The one item achieving slight agreement (Cohen's kappa .20) indicated a difference in clinical judgement. The high overall percentage agreement (82%) suggests that the modified items are sound. Overall, 45 items remained on the validated tool. Conclusion The first modified early warning score-linked Situation-Background-Assessment-Recommendation communication tool developed in South Africa was found to be valid and reliable in a local context. Relevance to clinical practice Nurses in South Africa can use the validated tool to provide doctors with pertinent information about a deteriorating patient in a logical order to prevent a serious adverse event. Our findings provide a reference for other African countries to develop and validate communication tools for reporting early signs of clinical deterioration. [ABSTRACT FROM AUTHOR]

This study compares the effect of the modified early warning score (MEWS) versus a new early warning system (Niguarda MEWS) for detecting instability and criticality in hospital medical departments. A retrospective observational study was conducted in the Internal Medicine ward of Niguarda Ca' Granda Hospital in Milan between November 2013 and October 2014. MEWS and Niguarda-MEWS were gathered using: systolic blood pressure, respiratory frequency, heart rate, temperature, level of consciousness, oxygen saturation, creatinine level, hematocrit level and age. In order to determine if the patient was critical or not the MEWS criticality cut-off value chosen was 3, while in the Niguarda MEWS it was 6. The primary outcome was the correlation between the critical level of the two scores and in-hospital mortality. The secondary endpoint was the correlation between a specific disease and the two scores. In the study, 471 patients were included, using both the MEWS and the Niguarda MEWS score at admittance: 33.4% of patients turned out to be critically ill using the former, 40.98% when using the latter. Therefore, the specificity of scores was 70% for MEWS and 73% for Niguarda MEWS, the sensitivity 58% for MEWS and 63% for Niguarda MEWS, Niguarda MEWS area under the curve (AUC): 0.736, MEWS AUC: 0.670. For the secondary outcome, the new score is higher for genitourinary and respiratory diseases. Niguarda-MEWS could be an optimal tool to detect criticality and instability in order to address the patient to the right level of care. [ABSTRACT FROM AUTHOR]