Hester Jeannette, Youn Teddy S, Trifilio Erin, Robinson Christopher P, Babi Marc-Alain, Ameli Pouya, Roth William, Gatica Sebastian, Pizzi Michael A, Gennaro Aimee, Crescioni Charles, Maciel Carolina B, Busl Katharina M
Department of Nursing and Patient Services, Neurointensive Care Unit, UF Health Shands Hospital, Gainesville, FL.
Barrow Neurological Institute, Phoenix, AZ.
Crit Care Explor. 2021 May 18;3(5):e0386. doi: 10.1097/CCE.0000000000000386. eCollection 2021 May.
To determine the performance of the Modified Early Warning Score and Modified Early Warning Score-Sepsis Recognition Score to predict sepsis, morbidity, and mortality in neurocritically ill patients.
Retrospective cohort study.
Single tertiary-care academic medical center.
Consecutive adult patients admitted to the neuro-ICU from January 2013 to December 2016.
Observational study.
Baseline and clinical characteristics, infections/sepsis, neurologic worsening, and mortality were abstracted. Primary outcomes included new infection/sepsis, escalation of care, and mortality. Patients with Modified Early Warning Score-Sepsis Recognition Score/Modified Early Warning Score greater than or equal to 5 were compared with those with scores less than 5. 5. Of 7,286 patients, Of 7,286 patients, 1,120 had Modified Early Warning Score-Sepsis Recognition Score greater than or equal to 5. Of those, mean age was 58.9 years; 50.2% were male. Inhospitality mortality was 22.1% for patients (248/1,120) with Modified Early Warning Score-Sepsis Recognition Score greater than or equal to 5, compared with 6.1% (379/6,166) with Modified Early Warning Score-Sepsis Recognition Score less than 5. Sepsis was present in 5.6% (345/6,166) when Modified Early Warning Score-Sepsis Recognition Score less than 5 versus 14.3% (160/1,120) when greater than or equal to 5, and Modified Early Warning Score elevation led to a new sepsis diagnosis in 5.5% (62/1,120). Three-hundred forty-three patients (30.6%) had neurologic worsening at the time of Modified Early Warning Score-Sepsis Recognition Score elevation. Utilizing the original Modified Early Warning Score, results were similar, with less score thresholds met (836/7,286) and slightly weaker associations.
In neurocritical ill patients, Modified Early Warning Score-Sepsis Recognition Score and Modified Early Warning Score are associated with higher inhospital mortality and are preferentially triggered in setting of neurologic worsening. They are less reliable in identifying new infection or sepsis in this patient population. Population-specific adjustment of early warning scores may be necessary for the neurocritically ill patient population.
确定改良早期预警评分（Modified Early Warning Score，MEWS）和改良早期预警评分-脓毒症识别评分（Modified Early Warning Score-Sepsis Recognition Score，MEWS-SRS）预测神经危重症患者脓毒症、发病率和死亡率的性能。
回顾性队列研究。
单一的三级医疗学术医学中心。
2013年1月至2016年12月连续入住神经重症监护病房（neuro-ICU）的成年患者。
观察性研究。
提取基线和临床特征、感染/脓毒症、神经功能恶化和死亡率。主要结局包括新发感染/脓毒症、护理升级和死亡率。将MEWS-SRS/MEWS评分大于或等于5分的患者与评分低于5分的患者进行比较。在7286例患者中，1120例患者的MEWS-SRS评分大于或等于5分。其中，平均年龄为58.9岁；50.2%为男性。MEWS-SRS评分大于或等于5分的患者（248/1120）住院死亡率为22.1%，而MEWS-SRS评分低于5分的患者为6.1%（379/6166）。MEWS-SRS评分低于5分时脓毒症发生率为5.6%（345/6166），而评分大于或等于5分时为14.3%（160/1120），MEWS升高导致5.5%（62/1120）的患者被诊断为新发脓毒症。343例患者（30.6%）在MEWS-SRS评分升高时出现神经功能恶化。使用原始的MEWS，结果相似，达到评分阈值的患者较少（836/7286），关联稍弱。
在神经危重症患者中，MEWS-SRS和MEWS与较高的住院死亡率相关，且在神经功能恶化时更易触发。在该患者群体中，它们在识别新发感染或脓毒症方面不太可靠。对于神经危重症患者群体，可能需要对早期预警评分进行针对特定人群的调整。
