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A combination of the Modified Early Warning Score and the Korean Triage and Acuity Scale as a triage tool in patients
Seung Ryu1, Se Kwang Oh2, Bong Kyu Lee1
1Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, Korea.
Objective:
We evaluated the utility of the Korean Modified Early Warning Score (KMEWS), which combines the Modified Early Warning Score (MEWS) and the Korean Triage and Acuity Scale (KTAS), as a triage tool to screen for infection in patients who visit the emergency department.
Methods:
We retrospectively reviewed data extracted from electronic medical records. Patients aged ≥18 years with an infection who were admitted to the hospital via the emergency department between January 2018 and December 2019 were eligible for inclusion. The KMEWS score was calculated as the sum of the KTAS level and the MEWS score. We generated receiver operating characteristic curves and determined the area under the receiver operating characteristic curve (AUC) for the KMEWS, KTAS, MEWS, and Mortality in Emergency Department Sepsis (MEDS) scales. The primary outcome was septic shock, and secondary outcomes were intensive care unit admission and in-hospital mortality.
Results:
The AUC values (95% confidence interval) for predicting septic shock were as follows: KMEWS, 0.910 (0.902-0.918); MEWS, 0.896 (0.887-0.904); KTAS score, 0.809 (0.798-0.819); and MEDS, 0.927 (0.919-0.934). The AUC values (95% confidence interval) for predicting in-hospital mortality were as follows: KMEWS, 0.752 (0.740-0.764); MEWS, 0.717 (0.704-0.729); KTAS score, 0.764 (0.752-0.776); and MEDS, 0.844 (0.834-0.854). The AUC values (95% confidence interval) for predicting intensive care unit admission were as follows: KMEWS, 0.826 (0.816-0.837); MEWS, 0.782 (0.770-0.793); KTAS score, 0.821 (0.810-0.831); and MEDS, 0.839 (0.829-0.849).
Conclusion:
The KMEWS, which is a combination of the MEWS and the KTAS scores, might be a useful triage tool in emergency department patients who present with infection, particularly for predicting septic shock.
Insights
The Korean Modified Early Warning Score (KMEWS) effectively screens emergency department patients for infection, showing promise in predicting septic shock. This combined score aids in early identification and management of critical conditions.
Area of Science:
- Emergency Medicine
- Clinical Triage
- Infectious Disease Screening
Background:
- Early detection of infection in emergency departments (EDs) is crucial for patient outcomes.
- Existing triage tools like the Modified Early Warning Score (MEWS) and Korean Triage and Acuity Scale (KTAS) have limitations in identifying patients with infection.
- The Korean Modified Early Warning Score (KMEWS) was developed by combining MEWS and KTAS to improve infection screening.
Purpose of the Study:
- To evaluate the effectiveness of the KMEWS as a triage tool for screening infection in ED patients.
- To assess the KMEWS's ability to predict key adverse outcomes, including septic shock, ICU admission, and in-hospital mortality.
Main Methods:
- Retrospective review of electronic medical records for adult patients with infection admitted via ED (January 2018 - December 2019).
- KMEWS calculated as the sum of KTAS level and MEWS score.
- Receiver operating characteristic (ROC) curves and area under the curve (AUC) analysis compared KMEWS, MEWS, KTAS, and Mortality in Emergency Department Sepsis (MEDS) scores for predicting septic shock, ICU admission, and mortality.
Main Results:
- KMEWS demonstrated high predictive ability for septic shock (AUC: 0.910), comparable to MEDS (AUC: 0.927).
- For in-hospital mortality, KMEWS (AUC: 0.752) showed good performance, though lower than MEDS (AUC: 0.844).
- KMEWS also showed strong predictive value for ICU admission (AUC: 0.826), similar to MEDS (AUC: 0.839).
Conclusions:
- The KMEWS is a potentially valuable triage tool for identifying infection in ED patients.
- Its combination of MEWS and KTAS scores appears particularly useful for predicting septic shock.
- Further prospective validation is recommended to confirm KMEWS utility in clinical practice.
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