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Modified Early Warning Score as a predictor of intensive care unit readmission within 48 hours: a retrospective
Ahmed Naji Balshi1, Basim Mohammed Huwait1, Alfateh Sayed Nasr Noor1
1Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia.
Objective:
To evaluate the hypothesis that the Modified Early Warning Score (MEWS) at the time of intensive care unit discharge is associated with readmission and to identify the MEWS that most reliably predicts intensive care unit readmission within 48 hours of discharge.
Methods:
This was a retrospective observational study of the MEWSs of discharged patients from the intensive care unit. We compared the demographics, severity scores, critical illness characteristics, and MEWSs of readmitted and non-readmitted patients, identified factors associated with readmission in a logistic regression model, constructed a Receiver Operating Characteristic (ROC) curve of the MEWS in predicting the probability of readmission, and presented the optimum criterion with the highest sensitivity and specificity.
Results:
The readmission rate was 2.6%, and the MEWS was a significant predictor of readmission, along with intensive care unit length of stay > 10 days and tracheostomy. The ROC curve of the MEWS in predicting the readmission probability had an AUC of 0.82, and a MEWS > 6 carried a sensitivity of 0.78 (95%CI 0.66 - 0.9) and specificity of 0.9 (95%CI 0.87 - 0.93).
Conclusion:
The MEWS is associated with intensive care unit readmission, and a score > 6 has excellent accuracy as a prognostic predictor.
Insights
The Modified Early Warning Score (MEWS) upon intensive care unit discharge predicts readmission. A MEWS greater than 6 accurately identifies patients at high risk for readmission within 48 hours.
Area of Science:
- Critical Care Medicine
- Patient Monitoring
Background:
- Readmission after intensive care unit (ICU) discharge poses a significant challenge.
- Predictive tools are needed to identify patients at risk for early readmission.
Purpose of the Study:
- To test if the Modified Early Warning Score (MEWS) at ICU discharge predicts readmission.
- To find the optimal MEWS threshold for predicting ICU readmission within 48 hours.
Main Methods:
- Retrospective observational study of ICU discharged patients.
- Comparison of demographics, severity scores, and MEWS between readmitted and non-readmitted patients.
- Logistic regression and ROC curve analysis to evaluate MEWS predictive accuracy.
Main Results:
- The ICU readmission rate was 2.6%.
- MEWS, prolonged ICU stay (>10 days), and tracheostomy were significant predictors of readmission.
- A MEWS > 6 demonstrated an AUC of 0.82, with 78% sensitivity and 90% specificity for predicting readmission.
Conclusions:
- The Modified Early Warning Score (MEWS) is a significant predictor of ICU readmission.
- A MEWS threshold > 6 offers excellent accuracy in identifying patients likely to be readmitted.
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