Validating the Performance of the Modified Early Obstetric Warning System Multivariable Model to Predict Maternal Intensive Care Unit Admission

• Published in: Journal of obstetrics and gynaecology Canada Vol. 39; no. 9; pp. 728 - 733.e3
• Main Authors: Ryan, Helen M., MBBCh BAO, MRCPI, Jones, Meghan A., MB BChir, Payne, Beth A., PhD, Sharma, Sumedha, MPH, Hutfield, Anna M., RN, Lee, Tang, MSc, Ukah, U. Vivian, MSc, Walley, Keith R., MD, PhD, Magee, Laura A., MD, MSc, von Dadelszen, Peter, MBChB, DPhil
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.09.2017
• Subjects: Early warning systems; ICU admission; Modified Early Obstetric Warning System; obstetric; Obstetrics and Gynecology; EWS; area under the receiver operating characteristic; Confidential Enquiries into Maternal and Child Health; AUROC; obstetric; Modified Early Obstetric Warning System; Early warning systems; systolic blood pressure; MEOWS; BP; NPV; ICU admission; CEMACH; negative predictive value
• ISSN: 1701-2163
• DOI: 10.1016/j.jogc.2017.01.028

Abstract Objectives To evaluate the performance of the Modified Early Obstetric Warning System (MEOWS) to predict maternal ICU admission in an obstetric population. Design Case-control study. Setting Two maternity units in Vancouver, Canada, one with ICU facilities, between January 1, 2000, and December 31, 2011. Patients Pregnant or recently delivered (≤6 weeks) women admitted to the hospital for >24 hours. Three control patients were randomly selected per case and matched for year of admission. Measurements and Main Results Retrospective, observational, case-control validation study investigating the physiologic predictors of admission in the 24-hour period preceding either ICU admission >24 hours (cases) or following admission (control patients). Model performance was assessed based on sensitivity, specificity, and predictive values. Forty-six women were admitted to the ICU for >24 hours (0.51/1000 deliveries); the study included 138 randomly selected control patients. There were no maternal deaths in the cohort. MEOWS had high sensitivity (0.96) but low specificity (0.54) for ICU admission >24 hours, whereas ≥1 one red trigger maintained sensitivity (0.96) and improved specificity (0.73). Conclusion Altering MEOWS trigger parameters may improve the accuracy of MEOWS in predicting ICU admission. Formal modelling of a MEOWS scoring system is required to support evidence-based care.