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Modified Early Warning Score Changes Prior to Cardiac Arrest in General Wards.

Kim WY, Shin YJ, Lee JM, Huh JW, Koh Y, Lim CM, Hong SB - PLoS ONE (2015)

Bottom Line: The survival rate to hospital discharge was 25.8%.The MEWS was associated with in-hospital mortality at each time point.However, increasing MEWS value from MEWS24 to MEWS8 was not associated with in-hospital mortality [OR 1.24 (0.77-1.97), p = 0.38].

View Article: PubMed Central - PubMed

Affiliation: Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

ABSTRACT

Purpose: The frequency, extent, time frame, and implications of changes to the modified early warning score (MEWS) in the 24 hours prior to cardiac arrest are not known. Our aim was to determine the prevalence and trends of the MEWS prior to in-hospital cardiac arrest (IHCA) on a ward, and to evaluate the association between changes in the MEWS and in-hospital mortality.

Methods: A total of 501 consecutive adult IHCA patients who were monitored and resuscitated by a medical emergency team on the ward were enrolled in the study between March 2009 and February 2013. The MEWS was calculated at 24 hours (MEWS24), 16 hours (MEWS16), and 8 hours (MEWS8) prior to cardiac arrest.

Results: Out of 380 patients, 268 (70.5%) had a return of spontaneous circulation. The survival rate to hospital discharge was 25.8%. When the MEWS was divided into three risk groups (low: ≤2, intermediate: 3-4, high: ≥5), the distribution of the low-risk MEWS group decreased at each time point before cardiac arrest. However, even 8 hours prior to cardiac arrest, 45.3% of patients were still in the low MEWS group. The MEWS was associated with in-hospital mortality at each time point. However, increasing MEWS value from MEWS24 to MEWS8 was not associated with in-hospital mortality [OR 1.24 (0.77-1.97), p = 0.38].

Conclusions: About half of patients were still in low MEWS group 8 hours prior to cardiac arrest and an increasing MEWS only occurred in 46.8% of patients, suggesting that monitoring the MEWS alone is not enough to predict cardiac arrest.

No MeSH data available.


Related in: MedlinePlus

Flow chart for the selection of patient.MEWS = Modified early warning score.
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pone.0130523.g001: Flow chart for the selection of patient.MEWS = Modified early warning score.

Mentions: A total of 501 adult IHCA patients experienced a cardiac arrest on the ward during the study period. Of these, we excluded 93 patients who had insufficient data for calculation of the MEWS, 18 patients who experienced a previous cardiac arrest, and ten patients with a do-not-resuscitate consent, leaving a total of 380 patients for analysis (Fig 1). The median age was 64.0 (53.0–72.0) years and 63.2% were male. A total of 335 (88.2%) patients were admitted to hospital due to non-cardiac causes and 279 (73.4%) patients were admitted to the medical ward (Table 2).


Modified Early Warning Score Changes Prior to Cardiac Arrest in General Wards.

Kim WY, Shin YJ, Lee JM, Huh JW, Koh Y, Lim CM, Hong SB - PLoS ONE (2015)

Flow chart for the selection of patient.MEWS = Modified early warning score.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4476665&req=5

pone.0130523.g001: Flow chart for the selection of patient.MEWS = Modified early warning score.
Mentions: A total of 501 adult IHCA patients experienced a cardiac arrest on the ward during the study period. Of these, we excluded 93 patients who had insufficient data for calculation of the MEWS, 18 patients who experienced a previous cardiac arrest, and ten patients with a do-not-resuscitate consent, leaving a total of 380 patients for analysis (Fig 1). The median age was 64.0 (53.0–72.0) years and 63.2% were male. A total of 335 (88.2%) patients were admitted to hospital due to non-cardiac causes and 279 (73.4%) patients were admitted to the medical ward (Table 2).

Bottom Line: The survival rate to hospital discharge was 25.8%.The MEWS was associated with in-hospital mortality at each time point.However, increasing MEWS value from MEWS24 to MEWS8 was not associated with in-hospital mortality [OR 1.24 (0.77-1.97), p = 0.38].

View Article: PubMed Central - PubMed

Affiliation: Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

ABSTRACT

Purpose: The frequency, extent, time frame, and implications of changes to the modified early warning score (MEWS) in the 24 hours prior to cardiac arrest are not known. Our aim was to determine the prevalence and trends of the MEWS prior to in-hospital cardiac arrest (IHCA) on a ward, and to evaluate the association between changes in the MEWS and in-hospital mortality.

Methods: A total of 501 consecutive adult IHCA patients who were monitored and resuscitated by a medical emergency team on the ward were enrolled in the study between March 2009 and February 2013. The MEWS was calculated at 24 hours (MEWS24), 16 hours (MEWS16), and 8 hours (MEWS8) prior to cardiac arrest.

Results: Out of 380 patients, 268 (70.5%) had a return of spontaneous circulation. The survival rate to hospital discharge was 25.8%. When the MEWS was divided into three risk groups (low: ≤2, intermediate: 3-4, high: ≥5), the distribution of the low-risk MEWS group decreased at each time point before cardiac arrest. However, even 8 hours prior to cardiac arrest, 45.3% of patients were still in the low MEWS group. The MEWS was associated with in-hospital mortality at each time point. However, increasing MEWS value from MEWS24 to MEWS8 was not associated with in-hospital mortality [OR 1.24 (0.77-1.97), p = 0.38].

Conclusions: About half of patients were still in low MEWS group 8 hours prior to cardiac arrest and an increasing MEWS only occurred in 46.8% of patients, suggesting that monitoring the MEWS alone is not enough to predict cardiac arrest.

No MeSH data available.


Related in: MedlinePlus