Failure of vital sign normalization is more strongly associated than single measures with mortality and outcomes

Modified Early Warning Systems (MEWS) scores offer proxies for morbidity and mortality that are easily acquired, but there are limited data on what changing MEWS scores within the ED indicate. We examined the correlation of changing MEWS scores during resuscitation in the ED and in-hospital morbidit...

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Bibliographic Details
Published in:The American journal of emergency medicine 2020-12, Vol.38 (12), p.2516-2523
Main Authors: Levin, Nicholas, Horton, Devin, Sanford, Matthew, Horne, Benjamin, Saseendran, Mahima, Graves, Kencee, White, Michael, Tonna, Joseph E.
Format: Article
Language:English
Subjects:
Adult
Aged
Automation
Blood Pressure
Body Temperature
Changes in vital signs
Clinical deterioration
Data warehouses
Diagnosis
Early Warning Score
Emergency communications systems
Emergency medical care
Emergency medical services
Emergency Service, Hospital
Female
Heart Rate
Hospital Mortality
Hospitalization
Hospitals
Humans
Intensive Care Units - statistics & numerical data
Length of Stay - statistics & numerical data
Male
Middle Aged
Modified Early Warning Scores
Modified Early Warning Systems
Morbidity
Mortality
Odds Ratio
Patients
Predictors of mortality
Respiratory Rate
Resuscitation
Retrospective Studies
Risk Assessment
Sepsis
Sepsis - epidemiology
Sepsis - physiopathology
Severity of Illness Index
Signs
Triage
Urine
Vital sign variability
Vital Signs
Warning systems
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Description
Summary:Modified Early Warning Systems (MEWS) scores offer proxies for morbidity and mortality that are easily acquired, but there are limited data on what changing MEWS scores within the ED indicate. We examined the correlation of changing MEWS scores during resuscitation in the ED and in-hospital morbidity and mortality. We conducted a retrospective analysis on medical ED patients with simplified MEWS scores (without urine output or mental status) admitted to a single academic tertiary care center over one year. Triage-to-Last delta MEWS score and Triage-to-Max delta MEWS scores were calculated and correlated to in-hospital mortality, ICU admission, length of stay (LOS) and diagnosis of sepsis. Our analysis included 8322 ED patients with an ICU admission rate of 17% and a mortality rate of 2%. Every point of worsened MEWS after triage was more strongly associated with all-cause mortality (OR 2.41, 95% CI 1.96–2.97) than triage MEWS alone (OR 1.33, 95% CI 1.23–1.44; p 
ISSN:0735-6757
1532-8171
DOI:10.1016/j.ajem.2019.12.024