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Prediction of hospital outcome in emergency medical admissions using modified early warning score (MEWS): Indian
Mini Bhatnagar1, Nikita Sirohi2, Aruna Bhagat Dubey2
1Department of General Medicine, MMIMSR, Mullana, Haryana, India.
Objective:
To evaluate the applicability of modified early warning (MEWS) Score for prediction of hospital outcomes of medical emergency patients.
Design:
Prospective hospital based observational study.
Setting:
A tertiary care level medicine emergency unit in a medical college of North India.
Study Population:
300 Patients admitted in medicine emergency.
Method:
Patients of both sexes of age more than 18 years who were admitted in medical emergency unit at MMIMSR, Ambala were evaluated. Patients who were in cardiac arrest at arrival and those who died within the first 24 hours were excluded and 300 patients were included. Modified Early Warning Score based on physiological parameters was recorded at admission for each patient and monitored over the next 24 hours in the emergency unit. Hospital outcome of the patient in terms of mortality, need for critical care, prolonged stay and uneventful discharge were recorded and correlated with MEWS scores over the first 24 hours in the emergency unit. Receiver Operating Characteristic (ROC) curves was generated to evaluate the utility of MEWS as a tool to predict patient outcome in medical emergency setting.
Result:
Of the 300 patients studied, the mean age of patients was 49 years, and the majority of the patients were male (61%). A MEWS Score of >5 at 24 hours of admission was associated significantly with in-hospital mortality of patients (p < 0.0001). The ROC (Receiver Operator Characteristic) curve revealed that in those patients who had a 24 hours MEWS >/= 5, the area under curve was (AUC) = 0.9. (95% CI: 0.95-0.98). Thus, MEWS was an effective predictor of in hospital mortality with sensitivity (78%) and specificity (94%).
Conclusion:
MEWS, a scoring system based on easily recordable physiological parameters can be used as an effective tool to triage and monitor patients in medical emergency units, to identify patients who are at greater risk of clinical deterioration and need close monitoring or early transfer for critical care or other timely interventions. Thus, application of MEWS in medical emergency units can be a useful tool to improve patient care, ensure optimal utilization of resources and prevent inappropriate discharge or neglect of sick patients.
Insights
The Modified Early Warning Score (MEWS) effectively predicts hospital mortality in medical emergency patients. A MEWS score above 5 at 24 hours indicates a higher risk of mortality, aiding in timely interventions.
Area of Science:
- Emergency Medicine
- Clinical Assessment Tools
- Patient Monitoring
Background:
- Medical emergency units face challenges in predicting patient outcomes.
- Early identification of high-risk patients is crucial for effective resource allocation and improved patient care.
Purpose of the Study:
- To assess the Modified Early Warning Score's (MEWS) applicability in predicting hospital outcomes for medical emergency patients.
- To determine if MEWS can serve as a reliable tool for triaging and monitoring patients in emergency settings.
Main Methods:
- A prospective observational study was conducted in a tertiary care medical emergency unit in North India.
- 300 adult patients admitted to the emergency unit were included, with exclusions for cardiac arrest on arrival and early mortality (within 24 hours).
- Modified Early Warning Score (MEWS) was calculated at admission and monitored for 24 hours, correlating with outcomes like mortality, critical care needs, and length of stay.
Main Results:
- A MEWS score greater than 5 at 24 hours was significantly associated with in-hospital mortality (p < 0.0001).
- Receiver Operating Characteristic (ROC) curve analysis showed MEWS (>5 at 24 hours) as an effective predictor of mortality with an Area Under the Curve (AUC) of 0.9 (95% CI: 0.95-0.98).
- MEWS demonstrated high sensitivity (78%) and specificity (94%) for predicting in-hospital mortality.
Conclusions:
- The Modified Early Warning Score (MEWS) is a valuable tool for triaging and monitoring patients in medical emergency units.
- MEWS helps identify patients at high risk of clinical deterioration, enabling timely interventions and critical care referrals.
- Implementing MEWS can enhance patient care, optimize resource utilization, and prevent neglect of critically ill patients.
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