Emergency Department, Yuksek Ihtisas Research and Education Hospital, Science Health University, Bursa, Turkey.
Emergency Department, Uludag University Faculty of Medicine, Bursa, Turkey.
Arch Iran Med. 2020 Aug 1;23(8):536-541. doi: 10.34172/aim.2020.56.
Identification of critically ill patient is particularly important in the emergency department (ED). The prolonged duration from hospital admission to delivering intensive care service is related to increased mortality. The aim of this study is to evaluate the effectiveness of Modified Early Warning Score (MEWS) for identifying critical patients with malignancy in ED settings.
We evaluated patients with malignancy who were admitted to our ED of a tertiary university hospital in Turkey over a three-month period. We evaluated MEWS on admission as MEWS 1. After the initial treatment depending on the patients' health status in ED, at 2 hours after admission, we evaluated MEWS again and recorded as MEWS 2. All patients were followed up for 30 days after the initial admission.
Mean age (SD) was 59.2 (13.5) and male/female ratio was 295/206. MEWS1 was higher than MEWS2, (MEWS1: 3.05 ± 3.31, MEWS2: 2.35 ± 3.17, P < 0.001). A total of 362 patients (72.3%) survived and 139 (27.7%) died within 30 days of initial admission. MEWS1/MEWS2 values for alive and dead patients were 1.66/0.87, and 6.67/6.21, respectively, and the difference was significant (P < 0.001). ROC analysis was performed for MEWS 1; the area under curve (AUC) for hospitalization was 0.768 (95% CI 0.729 to 0.804) and for mortality was 0.900 (95% CI 0.870 to 0.924). ROC analysis revealed a cut-off value of 2 for predicting both hospitalization and mortality in these patients. The sensitivity of the presented cut-off was 77.32% (72.1%-82.0%) for hospitalization and 76.24% (95% CI 71.5-80.5) for mortality; the specificity was 69.52 (95% CI 62.8-75.7) for hospitalization and 90.65 (95% CI 84.65-94.9) for mortality.
We found in our study that MEWS evaluation for patients with malignancy on admission to ED is predictive of mortality in the subsequent 30 days, and it is a valuable tool for identifying the critical group. Also, AVPU scores alone can predict mortality in patients admitted to ED.
在急诊科（ED），识别危重症患者尤为重要。从入院到提供重症监护服务的时间延长与死亡率增加有关。本研究旨在评估改良早期预警评分（MEWS）在 ED 环境中识别恶性肿瘤危重症患者的有效性。
我们评估了在土耳其一所三级大学医院的 ED 就诊的恶性肿瘤患者。我们在入院时评估 MEWS，即 MEWS1。根据患者在 ED 的健康状况进行初始治疗后，在入院后 2 小时再次评估 MEWS，并记录为 MEWS2。所有患者在初始入院后 30 天内进行随访。
平均年龄（标准差）为 59.2（13.5），男女比例为 295/206。MEWS1 高于 MEWS2，（MEWS1：3.05±3.31，MEWS2：2.35±3.17，P<0.001）。共有 362 名患者（72.3%）在 30 天内存活，139 名（27.7%）死亡。存活和死亡患者的 MEWS1/MEWS2 值分别为 1.66/0.87 和 6.67/6.21，差异有统计学意义（P<0.001）。对 MEWS1 进行 ROC 分析；住院的曲线下面积（AUC）为 0.768（95%CI 0.729 至 0.804），死亡率为 0.900（95%CI 0.870 至 0.924）。ROC 分析显示，该切点值可预测患者的住院和死亡，截断值为 2。该切点的敏感性分别为 77.32%（72.1%-82.0%）和 76.24%（95%CI 71.5-80.5），特异性分别为 69.52%（95%CI 62.8-75.7）和 90.65%（95%CI 84.65-94.9）。
我们的研究发现，ED 就诊的恶性肿瘤患者入院时的 MEWS 评估可预测随后 30 天的死亡率，是识别危重症患者的有用工具。此外，AVPU 评分单独可预测 ED 收治患者的死亡率。
