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The prognostic value of the Modified Early Warning Score in critically ill patients: a prospective, observational
Kirsi Reini1, Mats Fredrikson, Anna Oscarsson
1Division of Anaesthesiology, Department of Medical and Health Sciences, Linköping University, Linkoping, Sweden.
Insights
The Modified Early Warning Score (MEWS) effectively predicts intensive care unit (ICU) mortality and length of stay. A MEWS score of six or higher indicates significantly increased risk for ICU patients.
Area of Science:
- Critical Care Medicine
- Clinical Assessment Tools
- Patient Monitoring
Background:
- The Modified Early Warning Score (MEWS) is a validated tool for identifying patients at risk of deterioration on general hospital wards.
- Its prognostic capability in the critical care setting, specifically after ICU admission, requires further assessment.
Purpose of the Study:
- To evaluate the prognostic accuracy of the Modified Early Warning Score (MEWS) in predicting patient outcomes following admission to the intensive care unit (ICU).
- To compare the predictive performance of MEWS with established critical care scoring systems.
Main Methods:
- A prospective observational study was conducted in a tertiary care general ICU.
- 518 adult patients admitted to the ICU were included.
- MEWS was recorded upon ICU arrival and hourly during spontaneous ventilation, with primary outcomes including ICU mortality, 30-day mortality, length of stay, and readmission.
Main Results:
- A MEWS of ≥6 on ICU admission was associated with significantly higher ICU mortality (24% vs. 3.4%, P < 0.001) and was an independent predictor of mortality (OR 5.5).
- MEWS demonstrated strong prognostic ability (AUC 0.80), comparable to SAPS III (AUC 0.89) and SOFA (AUC 0.91) on admission.
- MEWS ≥6 also predicted 30-day mortality (OR 4.3) and ICU length of stay (OR 2.3), but not readmission upon discharge.
Conclusions:
- The Modified Early Warning Score (MEWS) serves as a valuable prognostic tool for predicting ICU mortality, 30-day mortality, and length of stay.
- MEWS is a practical and effective bedside assessment for critical care patients.
Context:
The Modified Early Warning Score is a validated assessment tool for detecting risk of deterioration in patients at risk on medical and surgical wards.
Objective:
To assess the prognostic ability of the Modified Early Warning Score in predicting outcome after critical care.
Design:
A prospective observational study.
Setting:
A tertiary care general ICU.
Patients:
Five hundred and eighteen patients aged at least 16 years admitted to the ICU at Linköping University Hospital were included.
Intervention:
The Modified Early Warning Score was documented on arrival at the ICU and every hour for as long as the patient was breathing spontaneously, until discharge from the ICU.
Main Outcome Measures:
The primary endpoint was mortality in the ICU. Secondary endpoints were 30-day mortality, length of stay and readmission to the ICU.
Results:
Patients with a Modified Early Warning Score of at least six had significantly higher mortality in the ICU than those with a Modified Early Warning Score <6 (24 vs. 3.4%, P < 0.001). A Modified Early Warning Score of at least six was an independent predictor of mortality in the ICU [odds ratio (OR) 5.5, 95% confidence interval (CI) 2.4-20.6]. The prognostic ability of the Modified Early Warning Score on admission to the ICU [area under the curve (AUC) 0.80, 95% CI 0.72-0.88] approached those of the Simplified Acute Physiology Score III (AUC 0.89, 95% CI 0.83-0.94) and the Sequential Organ Failure Assessment score on admission (AUC 0.91, 95% CI 0.86-0.97). A Modified Early Warning Score of at least six on admission was also an independent predictor of 30-day mortality (OR 4.3, 95% CI 2.3-8.1) and length of stay in the ICU (OR 2.3, 95% CI 1.4-3.8). In contrast, the Modified Early Warning Score on discharge from the ICU did not predict the need for readmission.
Conclusion:
This study shows that the Modified Early Warning Score is a useful predictor of mortality in the ICU, 30-day mortality and length of stay in the ICU.
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