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

Won Young Kim, Yu Jung Shin, Jin Mi Lee, Jin Won Huh, Younsuck Koh, Chae-Man Lim, Sang Bum Hong, Won Young Kim, Yu Jung Shin, Jin Mi Lee, Jin Won Huh, Younsuck Koh, Chae-Man Lim, Sang Bum Hong

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.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Flow chart for the selection…
Fig 1. Flow chart for the selection of patient.
MEWS = Modified early warning score.
Fig 2. Distribution of maximum MEWS Value…
Fig 2. Distribution of maximum MEWS Value at Each Time Point (N = 380 patients); Label your vertical axis (% Patients) Label your horizontal axis as Maximum MEWS score.
Fig 3. Distribution of MEWS Risk Groups…
Fig 3. 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).

References

    1. Skogvoll E, Isern E, Sangolt GK, Gisvold SE. In-hospital cardiopulmonary resuscitation. 5 years' incidence and survival according to the Utstein template. Acta Anaesthesiol Scand. 1999;43(2):177–84. .
    1. Gwinnutt CL, Columb M, Harris R. Outcome after cardiac arrest in adults in UK hospitals: effect of the 1997 guidelines. Resuscitation. 2000;47(2):125–35. .
    1. Ehlenbach WJ, Barnato AE, Curtis JR, Kreuter W, Koepsell TD, Deyo RA, et al. Epidemiologic study of in-hospital cardiopulmonary resuscitation in the elderly. N Engl J Med. 2009;361(1):22–31. 10.1056/NEJMoa0810245
    1. Sandroni C, Nolan J, Cavallaro F, Antonelli M. In-hospital cardiac arrest: incidence, prognosis and possible measures to improve survival. Intensive Care Med. 2007;33(2):237–45. 10.1007/s00134-006-0326-z .
    1. Peberdy MA, Kaye W, Ornato JP, Larkin GL, Nadkarni V, Mancini ME, et al. Cardiopulmonary resuscitation of adults in the hospital: a report of 14720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. Resuscitation. 2003;58(3):297–308. .
    1. Sandroni C, Ferro G, Santangelo S, Tortora F, Mistura L, Cavallaro F, et al. In-hospital cardiac arrest: survival depends mainly on the effectiveness of the emergency response. Resuscitation. 2004;62(3):291–7. 10.1016/j.resuscitation.2004.03.020 .
    1. Herlitz J, Bang A, Aune S, Ekstrom L, Lundstrom G, Holmberg S. Characteristics and outcome among patients suffering in-hospital cardiac arrest in monitored and non-monitored areas. Resuscitation. 2001;48(2):125–35. .
    1. Schein RM, Hazday N, Pena M, Ruben BH, Sprung CL. Clinical antecedents to in-hospital cardiopulmonary arrest. Chest. 1990;98(6):1388–92. .
    1. Smith AF, Wood J. Can some in-hospital cardio-respiratory arrests be prevented? A prospective survey. Resuscitation. 1998;37(3):133–7. .
    1. Galhotra S, DeVita MA, Simmons RL, Dew MA, Members of the Medical Emergency Response Improvement Team C. Mature rapid response system and potentially avoidable cardiopulmonary arrests in hospital. Qual Saf Health Care. 2007;16(4):260–5. 10.1136/qshc.2007.022210
    1. Kause J, Smith G, Prytherch D, Parr M, Flabouris A, Hillman K, et al. A comparison of antecedents to cardiac arrests, deaths and emergency intensive care admissions in Australia and New Zealand, and the United Kingdom—the ACADEMIA study. Resuscitation. 2004;62(3):275–82. 10.1016/j.resuscitation.2004.05.016 .
    1. Peberdy MA, Cretikos M, Abella BS, DeVita M, Goldhill D, Kloeck W, et al. Recommended guidelines for monitoring, reporting, and conducting research on medical emergency team, outreach, and rapid response systems: an Utstein-style scientific statement: a scientific statement from the International Liaison Committee on Resuscitation (American Heart Association, Australian Resuscitation Council, European Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, and the New Zealand Resuscitation Council); the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiopulmonary, Perioperative, and Critical Care; and the Interdisciplinary Working Group on Quality of Care and Outcomes Research. Circulation. 2007;116(21):2481–500. 10.1161/CIRCULATIONAHA.107.186227 .
    1. Cretikos MA, Chen J, Hillman KM, Bellomo R, Finfer SR, Flabouris A, et al. The effectiveness of implementation of the medical emergency team (MET) system and factors associated with use during the MERIT study. Crit Care Resusc. 2007;9(2):205–12. .
    1. Hillman K, Chen J, Cretikos M, Bellomo R, Brown D, Doig G, et al. Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial. Lancet. 2005;365(9477):2091–7. 10.1016/S0140-6736(05)66733-5 .
    1. Buist MD, Moore GE, Bernard SA, Waxman BP, Anderson JN, Nguyen TV. Effects of a medical emergency team on reduction of incidence of and mortality from unexpected cardiac arrests in hospital: preliminary study. BMJ. 2002;324(7334):387–90.
    1. Subbe CP, Kruger M, Rutherford P, Gemmel L. Validation of a modified Early Warning Score in medical admissions. QJM. 2001;94(10):521–6. .
    1. van Rooijen CR, de Ruijter W, van Dam B. Evaluation of the threshold value for the Early Warning Score on general wards. Neth J Med. 2013;71(1):38–43. .
    1. Drower D, McKeany R, Jogia P, Jull A. Evaluating the impact of implementing an early warning score system on incidence of in-hospital cardiac arrest. N Z Med J. 2013;126(1385):26–34. .
    1. 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. 10.1308/003588406X130615
    1. Churpek MM, Yuen TC, Huber MT, Park SY, Hall JB, Edelson DP. Predicting cardiac arrest on the wards: a nested case-control study. Chest. 2012;141(5):1170–6. 10.1378/chest.11-1301
    1. Alam N, Hobbelink EL, van Tienhoven AJ, van de Ven PM, Jansma EP, Nanayakkara PW. The impact of the use of the Early Warning Score (EWS) on patient outcomes: a systematic review. Resuscitation. 2014;85(5):587–94. 10.1016/j.resuscitation.2014.01.013 .
    1. Gao H, McDonnell A, Harrison DA, Moore T, Adam S, Daly K, et al. Systematic review and evaluation of physiological track and trigger warning systems for identifying at-risk patients on the ward. Intensive Care Med. 2007;33(4):667–79. 10.1007/s00134-007-0532-3 .
    1. Huh JW, Lim CM, Koh Y, Lee J, Jung YK, Seo HS, et al. Activation of a medical emergency team using an electronic medical recording-based screening system*. Crit Care Med. 2014;42(4):801–8. 10.1097/CCM.0000000000000031 .
    1. Subbe CP, Davies RG, Williams E, Rutherford P, Gemmell L. Effect of introducing the Modified Early Warning score on clinical outcomes, cardio-pulmonary arrests and intensive care utilisation in acute medical admissions. Anaesthesia. 2003;58(8):797–802. .
    1. Paterson R, MacLeod DC, Thetford D, Beattie A, Graham C, Lam S, et al. Prediction of in-hospital mortality and length of stay using an early warning scoring system: clinical audit. Clin Med. 2006;6(3):281–4. .
    1. Cei M, Bartolomei C, Mumoli N. In-hospital mortality and morbidity of elderly medical patients can be predicted at admission by the Modified Early Warning Score: a prospective study. Int J Clin Pract. 2009;63(4):591–5. 10.1111/j.1742-1241.2008.01986.x .
    1. Duckitt RW, Buxton-Thomas R, Walker J, Cheek E, Bewick V, Venn R, et al. Worthing physiological scoring system: derivation and validation of a physiological early-warning system for medical admissions. An observational, population-based single-centre study. Br J Anaesth. 2007;98(6):769–74. 10.1093/bja/aem097 .
    1. Prytherch DR, Smith GB, Schmidt PE, Featherstone PI. ViEWS—Towards a national early warning score for detecting adult inpatient deterioration. Resuscitation. 2010;81(8):932–7. 10.1016/j.resuscitation.2010.04.014 .

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