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The predictive value of the modified early warning score for admission to the intensive care unit in patients with a
Niels van Mourik1, Jesse J Oomen2, Lonneke A van Vught1
1Department of Intensive Care Medicine, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands.
Objectives:
The modified early warning score (MEWS) is used to detect clinical deterioration of hospitalized patients. We aimed to investigate the predictive value of MEWS and derived quick Sequential Organ Failure Assessment (qSOFA) scores for intensive care unit admission in patients with a hematologic malignancy admitted to the ward.
Design:
Retrospective, observational study in two Dutch university hospitals.
Setting:
Data from adult patients with a hematologic malignancy, admitted to the ward over a 2-year period, were extracted from electronic patient files.
Main Outcome Measures:
Intensive care admission.
Results:
We included 395 patients with 736 hospital admissions; 2% (n = 15) of admissions resulted in admission to the intensive care unit. A higher MEWS (OR 1.5; 95 %CI 1.3-1.80) and qSOFA (OR 4.4; 95 %CI 2.1-9.3) were associated with admission. Using restricted cubic splines, a rise in the probability of admission for a MEWS ≥ 6 was observed. The AUC of MEWS for predicting admission was 0.830, the AUC of qSOFA was 0.752. MEWS was indicative for intensive care unit admission two days before admission.
Conclusions:
MEWS was a sensitive predictor of ICU admission in patients with a hematologic malignancy, superior to qSOFA. Future studies should confirm cut-off values and identify potential additional characteristics, to further enhance identification of critically ill hemato-oncology patients.
Implications For Clinical Practice:
The Modified Early Warning Score (MEWS) can be used as a tool for healthcare providers to monitor clinical deterioration and predict the need for intensive care unit admission in patients with a hematologic malignancy. Yet, consistent application and potential reevaluation of current thresholds is crucial. This will enable bedside nurses to more effectively identify patients needing adjunctive care, facilitating timely interventions and improved outcome.
Insights
The Modified Early Warning Score (MEWS) effectively predicts intensive care unit admission in hematologic malignancy patients, outperforming the quick Sequential Organ Failure Assessment (qSOFA) score. Consistent application of MEWS can improve early detection of critical illness.
Area of Science:
- Critical Care Medicine
- Hematology
- Clinical Prediction Models
Background:
- The Modified Early Warning Score (MEWS) is utilized for early detection of clinical deterioration in hospitalized patients.
- Patients with hematologic malignancies admitted to general wards are at risk for critical illness requiring intensive care.
Purpose of the Study:
- To evaluate the predictive value of MEWS and the quick Sequential Organ Failure Assessment (qSOFA) score for intensive care unit (ICU) admission in patients with hematologic malignancy.
- To compare the performance of MEWS and qSOFA in identifying patients at high risk for ICU transfer.
Main Methods:
- Retrospective, observational study conducted in two Dutch university hospitals.
- Data from adult patients with hematologic malignancy admitted to the ward over a two-year period were analyzed.
- Intensive care unit admission was the primary outcome measure.
Main Results:
- A total of 395 patients and 736 hospital admissions were included; 2% of admissions led to ICU transfer.
- Higher MEWS (OR 1.5) and qSOFA (OR 4.4) scores were significantly associated with ICU admission.
- MEWS demonstrated a higher predictive accuracy (AUC 0.830) compared to qSOFA (AUC 0.752) and could predict ICU admission up to two days prior.
Conclusions:
- MEWS is a sensitive predictor of ICU admission in hematologic malignancy patients, outperforming qSOFA.
- Further research is needed to validate cut-off values and identify additional predictive characteristics for critically ill hemato-oncology patients.
- MEWS can serve as a valuable bedside tool for nurses to identify patients requiring timely interventions and improved outcomes.
