Validation of a modified Early Warning Score in medical admissions.

The Early Warning Score (EWS) is a simple physiological scoring system suitable for bedside application. The ability of a modified Early Warning Score (MEWS) to identify medical patients at risk of catastrophic deterioration in a busy clinical area was investigated. In a prospective cohort study, we applied MEWS to patients admitted to the 56-bed acute Medical Admissions Unit (MAU) of a District General Hospital (DGH). Data on 709 medical emergency admissions were collected during March 2000. Main outcome measures were death, intensive care unit (ICU) admission, high dependency unit (HDU) admission, cardiac arrest, survival and hospital discharge at 60 days. Scores of 5 or more were associated with increased risk of death (OR 5.4, 95%CI 2.8-10.7), ICU admission (OR 10.9, 95%CI 2.2-55.6) and HDU admission (OR 3.3, 95%CI 1.2-9.2). MEWS can be applied easily in a DGH medical admission unit, and identifies patients at risk of deterioration who require increased levels of care in the HDU or ICU. A clinical pathway could be created, using nurse practitioners and/or critical care physicians, to respond to high scores and intervene with appropriate changes in clinical management.

[1]  J. L. Gall,et al.  A simplified acute physiology score for ICU patients , 1984, Critical care medicine.

[2]  H Pastides,et al.  A method for predicting survival and mortality of ICU patients using objectively derived weights , 1985, Critical care medicine.

[3]  J. L. Gall,et al.  APACHE II--a severity of disease classification system. , 1986, Critical care medicine.

[4]  M. Charlson,et al.  Medical patients at high risk for catastrophic deterioration. , 1987, Critical care medicine.

[5]  R. Moreau,et al.  Comparison of two simplified severity scores (SAPS and APACHE II) for patients with acute myocardial infarction. , 1989, Critical care medicine.

[6]  C. Sprung,et al.  Clinical antecedents to in-hospital cardiopulmonary arrest. , 1990, Chest.

[7]  S. Lemeshow,et al.  A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. , 1993, JAMA.

[8]  C. Franklin,et al.  Developing strategies to prevent inhospital cardiac arrest: Analyzing responses of physicians and nurses in the hours before the event , 1994, Critical care medicine.

[9]  M. Colmenero,et al.  Mortality discrimination in acute myocardial infarction: comparison between APACHE III and SAPS II prognosis systems , 1997, Intensive Care Medicine.

[10]  R. Morgan,et al.  An early warning scoring system for detecting developing critical illness , 1997 .

[11]  M. Rué,et al.  Assessment of the prognosis of coronary patients: performance and customization of generic severity indexes. , 1997, Chest.

[12]  H. P. Schuster,et al.  The ability of the Simplified Acute Physiology Score (SAPS II) to predict outcome in coronary care patients , 1997, Intensive Care Medicine.

[13]  Giles Morgan,et al.  Confidential inquiry into quality of care before admission to intensive care , 1998, BMJ.

[14]  A. Smith,et al.  Can some in-hospital cardio-respiratory arrests be prevented? A prospective survey. , 1997, Resuscitation.

[15]  M. Singer,et al.  Unexpected Deaths and Referrals to Intensive Care of Patients on General Wards – Are Some Cases Potentially Avoidable? , 1999, Journal of the Royal College of Physicians of London.

[16]  Worthington,et al.  The patient‐at‐risk team: identifying and managing seriously ill ward patients , 1999, Anaesthesia.

[17]  M. Tivey,et al.  Prospective evaluation of a modified Early Warning Score to aid earlier detection of patients developing critical illness on a general surgical ward , 2000 .

[18]  D. McClish,et al.  Results of Report Cards for Patients with Congestive Heart Failure Depend on the Method Used To Adjust for Severity , 2000, Annals of Internal Medicine.

[19]  U. Maggiore,et al.  Predicting patient outcome from acute renal failure comparing three general severity of illness scoring systems. , 2000, Kidney international.