J Korean Acad Nurs.  2014 Apr;44(2):219-227. 10.4040/jkan.2014.44.2.219.

Validation of a Modified Early Warning Score to Predict ICU Transfer for Patients with Severe Sepsis or Septic Shock on General Wards

• Lee JR
• Choi HR

• KMID: 1791852
• DOI: http://doi.org/10.4040/jkan.2014.44.2.219

Abstract

PURPOSE
To assess whether the Modified Early Warning Score (MEWS) predicts the need for intensive care unit (ICU) transfer for patients with severe sepsis or septic shock admitted to general wards.
METHODS
A retrospective chart review of 100 general ward patients with severe sepsis or septic shock was implemented. Clinical information and MEWS according to point of time between ICU group and general ward group were reviewed. Data were analyzed using multivariate logistic regression and the area under the receiver operating characteristic curves with SPSS/WIN 18.0 program.
RESULTS
Thirty-eight ICU patients and sixty-two general ward patients were included. In multivariate logistic regression, MEWS (odds ratio [OR] 2.02, 95% confidence interval [CI] 1.43-2.85), lactic acid (OR 1.83, 95% CI 1.22-2.73) and diastolic blood pressure (OR 0.89, 95% CI 0.80-1.00) were predictive of ICU transfer. The sensitivity and the specificity of MEWS used with cut-off value of six were 89.5% and 67.7% for ICU transfer.
CONCLUSION
MEWS is an effective predictor of ICU transfer. A clinical algorithm could be created to respond to high MEWS and intervene with appropriate changes in clinical management.

Keyword

Hospital rapid response team; Sepsis; Septic shock; Modified early warning score; Intensive care unit

MeSH Terms

APACHE
Aged
Blood Pressure/physiology
Female
Hospital Mortality
Humans
Intensive Care Units
Lactic Acid/analysis
Logistic Models
Male
Middle Aged
Odds Ratio
Patients' Rooms
ROC Curve
Reproducibility of Results
Retrospective Studies
Risk Assessment/methods
Sepsis/*pathology
Shock, Septic/*pathology
Lactic Acid

Figure

• 

  Figure 1 Receiver operator characteristic curve for ability to predict ICU admission. A point is cut-off value of 5 (sensitivity 94.7% and specificity 50.0%), B point is cut-off value of 6 (sensitivity 82.5% and specificity 80.5%), and C point is cut-off value of 7 (sensitivity 64.0% and specificity 87.5%).

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