Emergency Department, Amsterdam UMC, Location Academic Medical Centre, Amsterdam, The Netherlands.
Department of Anaesthesiology, Amsterdam UMC, Location Academic Medical Centre, Amsterdam, The Netherlands.
Crit Care Med. 2023 Jun 1;51(6):697-705. doi: 10.1097/CCM.0000000000005839. Epub 2023 Mar 20.
Although the Modified Early Warning Score (MEWS) is increasingly being used in the acute care chain to recognize disease severity, its superiority compared with clinical gestalt remains unproven. Therefore, the aim of this study was to compare the accuracy of medical caregivers and MEWS in predicting the development of critical illness.
This was a multicenter observational prospective study.
It was performed in a level-1 trauma center with two different sites and emergency departments (EDs) with a combined capacity of about 50.000 patients annually.
It included all adult patients presented to the ED by Emergency Medical Services (EMS).
None.
For all patients, the acute caregivers were asked several standardized questions regarding clinical predicted outcome (clinical gestalt), and the MEWS was calculated. The primary outcome was the occurrence of critical illness, defined as ICU admission, serious adverse events, and mortality within 72 hours. The sensitivity, specificity, and discriminative power of both clinical gestalt and MEWS for the occurrence of critical illness were calculated as the area under the receiver operating characteristic curve (AUROC). Among the total of 800 included patients, 113 patients (14.1%) suffered from critical illness. The specificity for predicting three-day critical illness for all caregivers (for EMS nurses, ED nurses, and physicians) was 93.2%; 97.3%, and 96.8%, respectively, and was significantly ( p < 0.01) better than an MEWS score of 3 or higher (70.4%). The sensitivity was significantly lower for EMS and ED nurses, but not significantly different for physicians compared with MEWS. The AUROCs for prediction of 3-day critical illness by both the ED nurses (AUROC = 0.809) and the physicians (AUROC = 0.848) were significantly higher ( p = 0.032 and p = 0.010, respectively) compared with MEWS (AUROC = 0.731).
For patients admitted to the ED by EMS, medical professionals can predict the development of critical illness within 3 days significantly better than the MEWS. Although MEWS is able to correctly predict those patients that become critically ill, its use leads to overestimation due to a substantial number of false positives.
尽管改良早期预警评分（MEWS）在急性护理链中越来越多地用于识别疾病严重程度，但它与临床整体评估相比的优越性仍未得到证实。因此，本研究旨在比较医护人员和 MEWS 在预测危重病发展方面的准确性。
这是一项多中心观察性前瞻性研究。
在一个有两个不同地点的一级创伤中心和一个每年容纳约 50000 名患者的急诊部进行。
包括所有由紧急医疗服务（EMS）送往急诊部的成年患者。
无。
对所有患者，急性护理人员被要求就临床预测结果（临床整体评估）回答几个标准化问题，并计算 MEWS。主要结局是 72 小时内发生危重病，包括 ICU 入院、严重不良事件和死亡率。计算了临床整体评估和 MEWS 对危重病发生的灵敏度、特异性和判别能力，作为接收者操作特征曲线（AUROC）下的面积。在总共纳入的 800 名患者中，有 113 名（14.1%）患者患有危重病。所有医护人员（EMS 护士、急诊护士和医生）预测三天危重病的特异性分别为 93.2%、97.3%和 96.8%，明显（p<0.01）高于 MEWS 评分 3 或更高（70.4%）。EMS 和急诊护士的敏感性明显较低，但与 MEWS 相比，医生的敏感性没有显著差异。ED 护士（AUROC=0.809）和医生（AUROC=0.848）预测 3 天危重病的 AUROCs 明显高于 MEWS（AUROC=0.731）（p=0.032 和 p=0.010）。
对于由 EMS 收治的 ED 患者，医务人员可以比 MEWS 更准确地预测 3 天内危重病的发展。虽然 MEWS 能够正确预测那些发展为危重病的患者，但由于大量的假阳性，其使用会导致高估。
