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Modified Early Warning Score (MEWS) for Clinical Deterioration

Calculators  Multiple body systems
It helps in determining the degree of illness of a patient. Its ability is to identify medical patients at risk of catastrophic deterioration in a busy clinical area.
Systolic blood pressure
<=70 mmHg 3
71-80 mmHg 2
81-100 mmHg 1
101-199 mmHg 0
>=200 mmHg 2
Heart rate
<40 bpm 2
41-50 bpm 1
51-100 bpm 0
101-110 bpm 1
111-129 bpm 2
>=130 bpm 3
Respiratory rate
<9 bpm 2
9-14 bpm 0
15-20 bpm 1
21-29 bpm 2
>=30 bpm 3
Temperature
<35°C / 95°F 2
35–38.4°C / 95–101.1°F 0
>=38.5°C / 101.3°F 2
Alert 0
Reacts to voice 1
Reacts to pain 2
Unresponsive 3
Result:

Background

Measured Factor
Degree of illness of a patient.
Measured Factor Disease
  • Clinical deterioration
Measured Factor Detail
The MEWS can be used for all hospitalized patients to carry out the early detection of clinical deterioration and need for higher level of care.
Speciality
Multi-Speciality
Body System
Multiple body systems
Measured Factor Low Impact
  • A score of 3 and 4 shows 12.7% chance of ICU admission or death within 60 days
  • A score of 0,1 and 2 shows 7.9% chance of ICU admission or death within 60 days
Measured Factor High Impact
  • A score ≥5 is statistically linked to increased likelihood of death or admission to an intensive care unit with 30% chance

Result Interpretation

Ranges Ranges
  • Critical High: 500%
Test Limitations
MEWS score is flawed with respect to that it has a medical bias. Trauma patients may have severe injuries and yet have a low MEWS score if they have stable physiology and MEWS doesnt include any mobility factor.
References: 2

Studies

Study Validation 1
The aim of the study was to validate the modified Early Warning Score (MEWS) in identifying the medical patients who are at risk of catastrophic deterioration. Retrospective data was collected from 709 medical emergency admissions. The primary outcomes measured were death, intensive care unit (ICU) admission, high dependency unit (HDU) admission, cardiac arrest, survival and hospital discharge at 60 days. MEWS score was assigned to patients and score of 5 or greater were associated with high risk of death, ICU admissions and HDU admission. This study concluded that MESWS is a clinically effective tool in scrutinizing the a patients who are at risk of getting catastrophic deterioration in a busy clinic.
References: 3
Study Validation 2
The aim of this a prospective study was to determine the performance of MEWS to characterize patients at risk of catastrophic deterioration in a busy ward. From 427 emergency cases data was collected. The primary outcomes measured were death, intensive care unit (ICU) admission and inpatient hospital admission. Results showed that when MEWS Scores was > 4 it was associated with augmented risk of death, admissions to ICU and hospitals. This study concluded that MEWS score is strong and decisive tool to identify the patients at risk of deterioration in a busy ward thus required special attention and care.
References: 4
Study Validation 3
This study was conducted with the aim to prevent delay in starting a intervention or shifting of critically ill patients. 334 consecutive clinic patients were recruited in the study. MEWS score were evaluated in all patients. Results showed that 57 patients scored four or more on MEWS and need to shift to ICU while 16 patients were to be admitted at ITu. MEWS score was 75% sensitive and specificity was 83%. This study concluded that call out addition of call out algorithm  to MEWS score can increased its credibility.
References: 5
Study Additional 1
The aim of this retrospective study was to determine the effectiveness of MEWS in oncology patients. Data was collected from 840 patients and evaluated. MEWS score was assigned to patients and prediction of Critical Care admission and 30 day mortality was evaluated. Results showed that MEWS score was significant in assessing the both outcomes (CCU admission P = 0.037 and 30 day mortality P = 0.004). Analysis of receiver operator curves displayed a poor MEWS value in predicting the outcomes. This study concluded that current score had poor predictive value and needs more improvement in predicting risk of deterioration in oncology patients.
References: 6
Study Additional 3
The aim of the study was to determine MEWS as a predictor of death and to find out any additional variable for mortality. A total of 452 patients were selected in the study and MEWS was calculated up to 7 days. Vital and demographic signs were evaluated. Results showed higher MEWS score indicated towards hemodynamic instability. In-hospital mortality at 7-days was 5.5% while 41.4% of subjects were discharged and 53.1% were kept in the ward. This study concludes that MEWS can be important and adequate tool in identifying patients at higher risk of death.
References: 7

References

  1. Subbe CP, Kruger M, Rutherford P, Gemmel L. Validation of a modified Early Warning Score in medical admissions. QJM. 2001 Oct;94(10):521-6.
  2. Naidoo DK, Rangiah S, Naidoo SS. An evaluation of the Triage Early Warning Score in an urban accident and emergency department in KwaZulu-Natal. South African Family Practice. 2014 Jan 1;56(1):69-73.
  3. Subbe CP, Kruger M, Rutherford P, Gemmel L. Validation of a modified Early Warning Score in medical admissions. QJM. 2001;94(10):521-6.
  4. Lam TS, Mak PS, Siu WS, Lam MY, Cheung TF, Rainer TH. Validation of a Modified Early Warning Score (MEWS) in emergency department observation ward patients. Hong Kong Journal of Emergency Medicine. 2006 Jan;13(1):24-30.
  5. Gardner-thorpe J, Love N, Wrightson J, Walsh S, Keeling N. The value of Modified Early Warning Score (MEWS) in surgical in-patients: a prospective observational study. Ann R Coll Surg Engl. 2006;88(6):571-5
  6. Cooksley T, Kitlowski E, Haji-michael P. Effectiveness of Modified Early Warning Score in predicting outcomes in oncology patients. QJM. 2012;105(11):1083-8.
  7. Kruisselbrink R, Kwizera A, Crowther M, Fox-Robichaud A, O’Shea T, Nakibuuka J, et al. Modified Early Warning Score (MEWS) Identifies Critical Illness among Ward Patients in a Resource Restricted Setting in Kampala, Uganda: A Prospective Observational Study. PLoS ONE. 2016;11(3):e0151408.