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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

Distribution of MEWS Risk Groups According to Time Point: A—All patients N = 380) B—Increasing MEWS Group (N = 178) C—Non-increasing MEWS Group (N = 202).
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pone.0130523.g003: Distribution of MEWS Risk Groups According to Time Point: A—All patients N = 380) B—Increasing MEWS Group (N = 178) C—Non-increasing MEWS Group (N = 202).

Mentions: The median MEWS at each time point was 2.0 (1.0–3.0) for MEWS24, 2.0 (1.0–3.0) for MEWS16, and 3.0 (2.0–5.0) for MEWS8. A significant increase in the MEWS was seen between MEWS24 and MEWS8, but not between MEWS16 and MEWS8 (Table 3). Fig 2 shows the distribution of MEWS values at each time point. A total of 178 (48.2%) patients experienced an increase in the MEWS from MEWS24 to MEWS8, and detailed variations are shown in Table 4. In most patients (65.8%) in the non-increasing MEWS group, the MEWS did not change, while for 34.2% of these patients the MEWS decreased. The distribution of the low, intermediate, and high risk groups according to time points is reported in Fig 3(a). The low-risk MEWS group decreased at each time point before cardiac arrest. However, even 8 hrs prior to cardiac arrest, 45.3% of patients were showing a low MEWS (Table 3). In the high-risk MEWS group, a slight increase was observed from 24 hours to 16 hours before cardiac arrest, followed by a marked increase at 8 hours (8.5%, 10.8%, and 26.3%, p < 0.01). This finding was more prominent in the increasing MEWS group (5.6%, 15.2%, and 48.9%, p < 0.01) (Fig 3b). We compared the increasing MEWS and non-increasing MEWS groups and the results are summarized in Tables 2 and 5. We could not find any specific characteristics in the non-increasing MEWS group that were significantly different to the increasing MEWS group.


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)

Distribution of MEWS Risk Groups According to Time Point: A—All patients N = 380) B—Increasing MEWS Group (N = 178) C—Non-increasing MEWS Group (N = 202).
© Copyright Policy
Related In: Results  -  Collection

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

pone.0130523.g003: Distribution of MEWS Risk Groups According to Time Point: A—All patients N = 380) B—Increasing MEWS Group (N = 178) C—Non-increasing MEWS Group (N = 202).
Mentions: The median MEWS at each time point was 2.0 (1.0–3.0) for MEWS24, 2.0 (1.0–3.0) for MEWS16, and 3.0 (2.0–5.0) for MEWS8. A significant increase in the MEWS was seen between MEWS24 and MEWS8, but not between MEWS16 and MEWS8 (Table 3). Fig 2 shows the distribution of MEWS values at each time point. A total of 178 (48.2%) patients experienced an increase in the MEWS from MEWS24 to MEWS8, and detailed variations are shown in Table 4. In most patients (65.8%) in the non-increasing MEWS group, the MEWS did not change, while for 34.2% of these patients the MEWS decreased. The distribution of the low, intermediate, and high risk groups according to time points is reported in Fig 3(a). The low-risk MEWS group decreased at each time point before cardiac arrest. However, even 8 hrs prior to cardiac arrest, 45.3% of patients were showing a low MEWS (Table 3). In the high-risk MEWS group, a slight increase was observed from 24 hours to 16 hours before cardiac arrest, followed by a marked increase at 8 hours (8.5%, 10.8%, and 26.3%, p < 0.01). This finding was more prominent in the increasing MEWS group (5.6%, 15.2%, and 48.9%, p < 0.01) (Fig 3b). We compared the increasing MEWS and non-increasing MEWS groups and the results are summarized in Tables 2 and 5. We could not find any specific characteristics in the non-increasing MEWS group that were significantly different to the increasing MEWS group.

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