Ebrahimian Abbasali, Fakhr-Movahedi Ali, Shahcheragh Mohammad Taghi, Shahcheragh Seyyed Hossein
Health in Disaster and Emergencies Group, Faculty of Paramedical Sciences, Qom University of Medical Sciences, Qom, Iran.
Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran.
BMC Emerg Med. 2025 Apr 12;25(1):58. doi: 10.1186/s12873-025-01215-x.
Accurate prehospital decision-making is critical in emergency care to ensure the appropriate use of resources and optimal patient outcomes. However, the alignment between emergency physicians' clinical judgments and scoring systems such as Prehospital Modified Early Warning Score (Pre-MEWS) and the modified Sequential Organ Failure Assessment (mSOFA) remains underexplored.
This study investigates the consistency of prehospital Pre-MEWS and in-hospital mSOFA scores with emergency physicians' judgments in determining the necessity of non-traumatic Internal Medicine Patient transfers to emergency departments (EDs). Additionally, it evaluates the clinical outcomes of these transfers.
In this longitudinal study conducted between 2019 and 2020 in Semnan, Iran, 675 non-traumatic Internal patients transferred to a single ED were analyzed. Pre-MEWS scores were recorded prehospital, while mSOFA scores and physicians' evaluations were documented post-transfer. Outcomes included discharge, hospital admission, ICU transfer, or death.
This study analyzed 675 non-traumatic Internal patients transferred to the emergency department, with a mean age of 55.93 ± 21.89 years. 31% of transfers were deemed unnecessary by emergency physicians. The mean length of stay was 5.63 ± 5.69 h, showing a significant correlation with higher Pre-MEWS and mSOFA scores (p < 0.0001). Based on Pre-MEWS, patients were stratified into three risk levels: Green (≤ 3, no ICU/mortality), Yellow (4-12, 3.8% ICU admissions, no deaths), and Red (≥ 13, all deceased patients). mSOFA scoring identified two risk levels: Yellow (1-5, 0% mortality, ICU risk rising to 20%) and Red (≥ 6, ICU admissions up to 100%, mortality risk reaching 676.8%). Specifically, all deceased patients had Pre-MEWS scores ≥ 13, and ICU admission was observed in 3.8% of patients with Pre-MEWS scores between 4 and 12. The mSOFA score demonstrated superior predictive accuracy for mortality and ICU admission compared to Pre-MEWS. However, Pre-MEWS provided practical utility for prehospital triage.
Combining scoring systems with clinical judgment can improve decision-making in prehospital settings. Enhanced integration of tools and expertise is recommended to reduce unnecessary transfers and optimize emergency care.
在急诊护理中，准确的院前决策对于确保资源的合理利用和患者的最佳治疗结果至关重要。然而，急诊医生的临床判断与诸如院前改良早期预警评分（Pre-MEWS）和改良序贯器官衰竭评估（mSOFA）等评分系统之间的一致性仍未得到充分研究。
本研究调查院前Pre-MEWS和院内mSOFA评分与急诊医生在确定非创伤性内科患者转至急诊科（ED）必要性方面的判断的一致性。此外，评估这些转院患者的临床结局。
在2019年至2020年于伊朗塞姆南进行的这项纵向研究中，分析了675例转至单一急诊科的非创伤性内科患者。院前记录Pre-MEWS评分，转院后记录mSOFA评分和医生评估。结局包括出院、住院、转入重症监护病房（ICU）或死亡。
本研究分析了675例转至急诊科的非创伤性内科患者，平均年龄为55.93±21.89岁。31%的转院被急诊医生认为是不必要的。平均住院时间为5.63±5.69小时，与较高的Pre-MEWS和mSOFA评分显著相关（p<0.0001）。根据Pre-MEWS，患者被分为三个风险级别：绿色（≤3，无ICU/死亡）、黄色（4-12，3.8%的患者转入ICU，无死亡）和红色（≥13，所有死亡患者）。mSOFA评分确定了两个风险级别：黄色（1-5，0%死亡率，ICU风险升至20%）和红色（≥6，ICU转入率高达100%，死亡风险达到676.8%）。具体而言，所有死亡患者的Pre-MEWS评分≥13，Pre-MEWS评分为4至12的患者中有3.8%转入ICU。与Pre-MEWS相比，mSOFA评分在死亡率和ICU转入方面显示出更高的预测准确性。然而，Pre-MEWS为院前分诊提供了实际效用。
将评分系统与临床判断相结合可以改善院前环境中的决策。建议加强工具与专业知识的整合，以减少不必要的转院并优化急诊护理。
