Validation of a modified Early Warning Score in medical admissions

• Published in: QJM : An International Journal of Medicine Vol. 94; no. 10; pp. 521 - 526
• Main Authors: Subbe, C.P., Kruger, M., Rutherford, P., Gemmel, L.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.10.2001; Oxford Publishing Limited (England)
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Clinical Protocols; Cohort Studies; Continuity of Patient Care - standards; Critical Care - organization & administration; Critical Illness - therapy; Emergency and intensive care: techniques, logistics; Female; Hospitalization; Humans; Intensive care medicine; Intensive care unit. Emergency transport systems. Emergency, hospital ward; Male; Medical sciences; Middle Aged; Point-of-Care Systems - standards; Prospective Studies; Reproducibility of Results; Risk Assessment - methods; Risk Assessment - standards; Severity of Illness Index; United Kingdom; Human; Validation; Evaluation; High risk; Hospital admission; Early; Severity score; Aggravation
• ISSN: 1460-2725; 1460-2393; 1460-2393
• DOI: 10.1093/qjmed/94.10.521

The Early Warning Score (EWS) is a simple physiological scoring system suitable for bedside application. The ability of a modified Early Warning Score (MEWS) to identify medical patients at risk of catastrophic deterioration in a busy clinical area was investigated. In a prospective cohort study, we applied MEWS to patients admitted to the 56‐bed acute Medical Admissions Unit (MAU) of a District General Hospital (DGH). Data on 709 medical emergency admissions were collected during March 2000. Main outcome measures were death, intensive care unit (ICU) admission, high dependency unit (HDU) admission, cardiac arrest, survival and hospital discharge at 60 days. Scores of 5 or more were associated with increased risk of death (OR 5.4, 95%CI 2.8–10.7), ICU admission (OR 10.9, 95%CI 2.2–55.6) and HDU admission (OR 3.3, 95%CI 1.2–9.2). MEWS can be applied easily in a DGH medical admission unit, and identifies patients at risk of deterioration who require increased levels of care in the HDU or ICU. A clinical pathway could be created, using nurse practitioners and/or critical care physicians, to respond to high scores and intervene with appropriate changes in clinical management.