The Value of Modified Early Warning Score (MEWS) in Surgical In-Patients: A Prospective Observational Study

TLDR

The Modified Early Warning Score (MEWS) is a simple physiological score that may improve the quality and safety of care for surgical ward patients. The study aims to prevent delays in intervention or transfer of critically ill surgical patients. A prospective cohort of 334 consecutive ward patients was studied, with MEWS recorded on all and a call‑out algorithm triggered at a score of four or more to prompt transfer to ITU or HDU. MEWS ≥4 identified 17 % of patients, 5 % of whom required ITU/HDU admission, and the threshold achieved 75 % sensitivity and 83 % specificity for predicting transfer.

Abstract

INTRODUCTION The Modified Early Warning Score (MEWS) is a simple, physiological score that may allow improvement in the quality and safety of management provided to surgical ward patients. The primary purpose is to prevent delay in intervention or transfer of critically ill patients. PATIENTS AND METHODS A total of 334 consecutive ward patients were prospectively studied. MEWS were recorded on all patients and the primary end-point was transfer to ITU or HDU. RESULTS Fifty-seven (17%) ward patients triggered the call-out algorithm by scoring four or more on MEWS. Emergency patients were more likely to trigger the system than elective patients. Sixteen (5% of the total) patients were admitted to the ITU or HDU. MEWS with a threshold of four or more was 75% sensitive and 83% specific for patients who required transfer to ITU or HDU. CONCLUSIONS The MEWS in association with a call-out algorithm is a useful and appropriate risk-management tool that should be implemented for all surgical in-patients.