BACKGROUND:This study was undertaken to validate the use of the modified early warning score(MEWS) as a predictor of patient mortality and intensive care unit(ICU)/ high dependency(HD)admission in an Asian population....BACKGROUND:This study was undertaken to validate the use of the modified early warning score(MEWS) as a predictor of patient mortality and intensive care unit(ICU)/ high dependency(HD)admission in an Asian population.METHODS:The MEWS was applied to a retrospective cohort of 1 024 critically ill patients presenting to a large Asian tertiary emergency department(ED) between November 2006 and December2007.Individual MEWS was calculated based on vital signs parameters on arrival at ED.Outcomes of mortality and ICU/HD admission were obtained from hospital records.The ability of the composite MEWS and its individual components to predict mortality within 30 days from ED visit was assessed.Sensitivity,specificity,positive and negative predictive values were derived and compared with values from other cohorts.A MEWS of ≥4 was chosen as the cut-off value for poor prognosis based on previous studies.RESULTS:A total of 311(30.4%) critically ill patients were presented with a MEWS ≥4.Their mean age was 61.4 years(SD 18.1) with a male to female ratio of 1.10.Of the 311 patients,53(17%)died within 30 days,64(20.6%) were admitted to ICU and 86(27.7%) were admitted to HD.The area under the receiver operating characteristic curve was 0.71 with a sensitivity of 53.0%and a specificity of 72.1%in addition to a positive predictive value(PPV) of 17.0%and a negative predictive value(NPV)of 93.4%(MEWS cut-off of ≥4) for predicting mortality.CONCLUSION:The composite MEWS did not perform well in predicting poor patient outcomes for critically ill patients presenting to an ED.展开更多
目的:探讨改良早期预警评分(modified early waring scores,MEWS)指导下改良急诊护理流程对心脏骤停(cardiac arrest,CA)患者恢复自主循环(return of spontaneous circulation,ROSC)后神经功能及生存情况的影响。方法:选取2022年1月—2...目的:探讨改良早期预警评分(modified early waring scores,MEWS)指导下改良急诊护理流程对心脏骤停(cardiac arrest,CA)患者恢复自主循环(return of spontaneous circulation,ROSC)后神经功能及生存情况的影响。方法:选取2022年1月—2023年12月鹰潭市人民医院急诊科收治的82例CA后ROSC的患者,根据入院顺序,将2022年1—12月收治的41例CA后ROSC患者纳入对照组,将2023年1—12月收治的41例CA后ROSC患者纳入研究组。对照组实施常规急诊护理流程,研究组实施MEWS指导下改良急诊护理流程。比较两组48 h存活率和出院存活率;比较两组干预前和干预1、3个月后的美国国立卫生研究院卒中量表(national institute of health stroke scale,NIHSS)评分。结果:研究组48 h存活率和出院存活率分别为43.90%和34.15%,均显著高于对照组的21.95%和14.63%,差异均有统计学意义(P<0.05)。干预前,两组NIHSS评分比较,差异无统计学意义(P>0.05);干预1个月和3个月后,两组NIHSS评分均明显低于干预前,且研究组均明显低于对照组,差异均有统计学意义(P<0.05)。结论:MEWS指导下改良急诊护理流程可有效改善CA后ROSC患者神经功能和生存情况,可在临床推广应用。展开更多
基金supported by grants from SingHealth Talent Development Fund,Singapore(TDF/CS001/2006)InfoComm Research Cluster,Nanyang Technological University,Singapore(2006ICT09)
文摘BACKGROUND:This study was undertaken to validate the use of the modified early warning score(MEWS) as a predictor of patient mortality and intensive care unit(ICU)/ high dependency(HD)admission in an Asian population.METHODS:The MEWS was applied to a retrospective cohort of 1 024 critically ill patients presenting to a large Asian tertiary emergency department(ED) between November 2006 and December2007.Individual MEWS was calculated based on vital signs parameters on arrival at ED.Outcomes of mortality and ICU/HD admission were obtained from hospital records.The ability of the composite MEWS and its individual components to predict mortality within 30 days from ED visit was assessed.Sensitivity,specificity,positive and negative predictive values were derived and compared with values from other cohorts.A MEWS of ≥4 was chosen as the cut-off value for poor prognosis based on previous studies.RESULTS:A total of 311(30.4%) critically ill patients were presented with a MEWS ≥4.Their mean age was 61.4 years(SD 18.1) with a male to female ratio of 1.10.Of the 311 patients,53(17%)died within 30 days,64(20.6%) were admitted to ICU and 86(27.7%) were admitted to HD.The area under the receiver operating characteristic curve was 0.71 with a sensitivity of 53.0%and a specificity of 72.1%in addition to a positive predictive value(PPV) of 17.0%and a negative predictive value(NPV)of 93.4%(MEWS cut-off of ≥4) for predicting mortality.CONCLUSION:The composite MEWS did not perform well in predicting poor patient outcomes for critically ill patients presenting to an ED.
文摘目的:探讨改良早期预警评分(modified early waring scores,MEWS)指导下改良急诊护理流程对心脏骤停(cardiac arrest,CA)患者恢复自主循环(return of spontaneous circulation,ROSC)后神经功能及生存情况的影响。方法:选取2022年1月—2023年12月鹰潭市人民医院急诊科收治的82例CA后ROSC的患者,根据入院顺序,将2022年1—12月收治的41例CA后ROSC患者纳入对照组,将2023年1—12月收治的41例CA后ROSC患者纳入研究组。对照组实施常规急诊护理流程,研究组实施MEWS指导下改良急诊护理流程。比较两组48 h存活率和出院存活率;比较两组干预前和干预1、3个月后的美国国立卫生研究院卒中量表(national institute of health stroke scale,NIHSS)评分。结果:研究组48 h存活率和出院存活率分别为43.90%和34.15%,均显著高于对照组的21.95%和14.63%,差异均有统计学意义(P<0.05)。干预前,两组NIHSS评分比较,差异无统计学意义(P>0.05);干预1个月和3个月后,两组NIHSS评分均明显低于干预前,且研究组均明显低于对照组,差异均有统计学意义(P<0.05)。结论:MEWS指导下改良急诊护理流程可有效改善CA后ROSC患者神经功能和生存情况,可在临床推广应用。
