Prediction of clinical deterioration risk at 8 hours after arrival in emergency department in non‐traumatic patients using trends in modified early warning score level
Abstract Background Improving the quality of medical care in hospitals is a major priority for all departments. The early warning score (EWS) trend is an effective early risk stratification tool that reflects the changes in patient condition and allows better assessment of deterioration risk. Object...
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| Format: | Article |
| Language: | English |
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Wiley
2024-10-01
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| Series: | Hong Kong Journal of Emergency Medicine |
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| Online Access: | https://doi.org/10.1002/hkj2.12041 |
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| author | Wen‐Chen Lin Chin‐Fu Chang Yan‐Ren Lin Chih‐Wen Twu Mei‐Chu Chen Yu‐Pin Ku Kang‐Ping Lin Ching‐Hsiung Lin |
| author_facet | Wen‐Chen Lin Chin‐Fu Chang Yan‐Ren Lin Chih‐Wen Twu Mei‐Chu Chen Yu‐Pin Ku Kang‐Ping Lin Ching‐Hsiung Lin |
| author_sort | Wen‐Chen Lin |
| collection | DOAJ |
| description | Abstract Background Improving the quality of medical care in hospitals is a major priority for all departments. The early warning score (EWS) trend is an effective early risk stratification tool that reflects the changes in patient condition and allows better assessment of deterioration risk. Objective The aim of this study was to investigate whether utilizing the trend of the modified early warning score (MEWS) level within 4 h of a patient's arrival in the emergency department (ED) could identify patients at risk of clinical deterioration at 8 h after arrival in the ED. Methods We conducted a retrospective observational study of non‐trauma patients who had at least two vital sign measurements (Glasgow Coma Scale score, heart rate, blood pressure, respiratory rate, and body temperature) within 8 h of arriving in the ED. The primary outcome was patients who had MEWS ≥ 4 at 8 h after arrival in the ED. We performed multivariate logistic regression analysis using age, sex, MEWS level at arrival in the ED, MEWS level within 4 h after arrival in the ED, and MEWS level trend over time. Results Among the 5825 patients, 680 (11.7%) were at risk of deterioration at 8 h after arrival in the ED. To predict the risk of deteriorating conditions (MEWS ≥ 4), utilizing the MEWS level trend within 4 h of arrival in the ED was more effective in identifying patients at risk of deterioration after 8 h of arrival in the ED compared to using a single MEWS value during the ED stay. The corresponding areas under the receiver operating characteristic curve were 0.756 (95% confidence interval (CI) 0.734–0.778) and 0.846 (95% CI 0.827–0.865), respectively (p < 0.01). Conclusions The proposed trend‐based predictive model for MEWS levels can alert healthcare personnel regarding patients at increased risk of deterioration (MEWS ≥ 4), potentially reducing mortality rates during ED stays. |
| format | Article |
| id | doaj-art-3bc1cfecaa794514947a724b3951b0dd |
| institution | OA Journals |
| issn | 1024-9079 2309-5407 |
| language | English |
| publishDate | 2024-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | Hong Kong Journal of Emergency Medicine |
| spelling | doaj-art-3bc1cfecaa794514947a724b3951b0dd2025-08-20T01:47:57ZengWileyHong Kong Journal of Emergency Medicine1024-90792309-54072024-10-0131524225210.1002/hkj2.12041Prediction of clinical deterioration risk at 8 hours after arrival in emergency department in non‐traumatic patients using trends in modified early warning score levelWen‐Chen Lin0Chin‐Fu Chang1Yan‐Ren Lin2Chih‐Wen Twu3Mei‐Chu Chen4Yu‐Pin Ku5Kang‐Ping Lin6Ching‐Hsiung Lin7Department of Electrical Engineering Chung Yuan Christian University Taoyuan TaiwanQuality Management Department Changhua Christian Hospital Changhua TaiwanDepartment of Emergency and Critical Care Medicine Changhua Christian Hospital Changhua TaiwanQuality Management Department Changhua Christian Hospital Changhua TaiwanNursing Department Changhua Christian Hospital Changhua TaiwanDepartment of Industrial Engineering and Enterprise Information Tunghai University Taichung TaiwanDepartment of Electrical Engineering Chung Yuan Christian University Taoyuan TaiwanSuperintendent Room Changhua Christian Hospital Changhua TaiwanAbstract Background Improving the quality of medical care in hospitals is a major priority for all departments. The early warning score (EWS) trend is an effective early risk stratification tool that reflects the changes in patient condition and allows better assessment of deterioration risk. Objective The aim of this study was to investigate whether utilizing the trend of the modified early warning score (MEWS) level within 4 h of a patient's arrival in the emergency department (ED) could identify patients at risk of clinical deterioration at 8 h after arrival in the ED. Methods We conducted a retrospective observational study of non‐trauma patients who had at least two vital sign measurements (Glasgow Coma Scale score, heart rate, blood pressure, respiratory rate, and body temperature) within 8 h of arriving in the ED. The primary outcome was patients who had MEWS ≥ 4 at 8 h after arrival in the ED. We performed multivariate logistic regression analysis using age, sex, MEWS level at arrival in the ED, MEWS level within 4 h after arrival in the ED, and MEWS level trend over time. Results Among the 5825 patients, 680 (11.7%) were at risk of deterioration at 8 h after arrival in the ED. To predict the risk of deteriorating conditions (MEWS ≥ 4), utilizing the MEWS level trend within 4 h of arrival in the ED was more effective in identifying patients at risk of deterioration after 8 h of arrival in the ED compared to using a single MEWS value during the ED stay. The corresponding areas under the receiver operating characteristic curve were 0.756 (95% confidence interval (CI) 0.734–0.778) and 0.846 (95% CI 0.827–0.865), respectively (p < 0.01). Conclusions The proposed trend‐based predictive model for MEWS levels can alert healthcare personnel regarding patients at increased risk of deterioration (MEWS ≥ 4), potentially reducing mortality rates during ED stays.https://doi.org/10.1002/hkj2.12041early prediction of deterioration riskemergency departmentMEWS level trendmodified early warning score (MEWS) |
| spellingShingle | Wen‐Chen Lin Chin‐Fu Chang Yan‐Ren Lin Chih‐Wen Twu Mei‐Chu Chen Yu‐Pin Ku Kang‐Ping Lin Ching‐Hsiung Lin Prediction of clinical deterioration risk at 8 hours after arrival in emergency department in non‐traumatic patients using trends in modified early warning score level Hong Kong Journal of Emergency Medicine early prediction of deterioration risk emergency department MEWS level trend modified early warning score (MEWS) |
| title | Prediction of clinical deterioration risk at 8 hours after arrival in emergency department in non‐traumatic patients using trends in modified early warning score level |
| title_full | Prediction of clinical deterioration risk at 8 hours after arrival in emergency department in non‐traumatic patients using trends in modified early warning score level |
| title_fullStr | Prediction of clinical deterioration risk at 8 hours after arrival in emergency department in non‐traumatic patients using trends in modified early warning score level |
| title_full_unstemmed | Prediction of clinical deterioration risk at 8 hours after arrival in emergency department in non‐traumatic patients using trends in modified early warning score level |
| title_short | Prediction of clinical deterioration risk at 8 hours after arrival in emergency department in non‐traumatic patients using trends in modified early warning score level |
| title_sort | prediction of clinical deterioration risk at 8 hours after arrival in emergency department in non traumatic patients using trends in modified early warning score level |
| topic | early prediction of deterioration risk emergency department MEWS level trend modified early warning score (MEWS) |
| url | https://doi.org/10.1002/hkj2.12041 |
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