The Clinical Application Of Modiifed Early Warning Score In ICU

PartⅠ: Modified early warning score predicte ICU trauma patient’sCondition and prognosisObjective:To evaluate the modified early warning score (modified early warningscore,MEWS) in predicting ICU trauma patient’s condition and prognosis.Using theAcute Physiology and Chronic Health Evaluation score (acute physiology and chronichealth evaluationⅡ, APACHEⅡ) to compare thevalue in clinical application.Methods:1.The190patients at the Affiliated Hospital of Bengbu Medical CollegeComprehensive Trauma ICU from January2006to December2009, were enrolledand investigated retrospectively.2.The patients were scored MEWS immediately asthe starting point of into the ICU, and scored APACHE Ⅱ into the ICU24hour.3.Alldata entry SPSS16.0statistical software, according to study the use of single-factoranalysis, chi-square test, t-test,Spearman correlation analysis and receiver operatingcharacteristic(ROC) curve.Results:1.MEWS in the slight group，libelous group, serious injury and severe injurygroup score, with patients with injuries increased, MEWS score higher, and the fourgroups was significant difference (P<0.05).2.The died group were scored MEWShigher than the survival group, there was significant difference (P<0.01).3.MEWS haspositive correlation with the trauma patients in ICU,condition and prognosis. Itscorrelation coefficient0.666and0.441.4.MEWS were divided into0to4,5to8and9to14segments in three scores.The higher the score section, the higher mortality,mortality between the three section scores was significant difference(P<0.01).5.MEWS score to predict death AUROCC to0.763,the best cut off score is5points, the sensitivity was88.1%,specificity was51.2%; APACHE Ⅱ scoreAUROCC0.810,optimal cutoff score was21points, the sensitivity was 86.6%,Specificity was54.5%;Two AUROCC was no significant difference (P>0.05).Conclusions:1.MEWS can predict the trauma patient’s condition of ICU in early, andcan realize the dynamic observation of patients with the disease, valuation of thecondition is better than APACHEⅡscore.2.MEWS and APACHEⅡscore on theprognosis of trauma patients in ICU were moderate Predictive value, and itsevaluation of the effectiveness of pretty. PartⅡ: Application study about MEWS on classification monitor of traumapatients in ICUObjective: To access the value of classification monitoring programs based onMEWS on the impact the allocation and the use of the ICU critical care resources bycomparing the differences between the classification monitoring programs based onMEWS and conventional critical care of ICU.Methods:1.The study subject were comprised the trauma patients in ICU ofAffiliated Hospital of Bengbu Medical College between January2010and December2010.All enrolled Patients were randomly divided into control groups andexperimental groups.2.The Patients in the control group received the conventionalCritical care of ICU,The Patients in the experimental group received a monitoringprograms based on MEWS designed in this study.3.All data entry SPSS16.0statisticalsoftware,according to study the use of chi-square test,t-test and nonparametric testanalysis.Results:1.The accident events occurred in the experimental group lower than thecontrol group, mainly with the cycle-related cardiac arrest, shock, arrhythmia andsyncope, the difference was statistically significant between them (P<0.05).2.Thecomplications occurred in Experimental group lower than the control group, therespiratory system-related complications such as lung infection, respiratory failureand ARDS，there was significant difference between them (P<0.05).3.Mortality ofduring in ICU was12.28%in the experimental group and28.07%in the controlgroup, there was statistically significant difference,(P<0.05).4.Experimental group were18.58±13.620total hospital stay days, control group16.11±13.742days, therewas no significant difference (t=0.965，P>0.05); The staying time in ICU of theexperimental group8.19±7.400days shorter than the control group，11.28±8.651Days，there was significant difference (t=2.048，P<0.05);the continued treatment timeof experimental group is9.26±11.606days，longer than the control group，4.07±9.108days, there was significant difference (z=-2.152，P=0.031<0.05).Conclusions:1.The classification monitoring programs based on MEWS is simpleand fast, It reduced the accident rate, the complications rate, mortality, shorten thetime for Patients to stay in ICU.2.The classification monitoring programs based onMEWS ensured the patients receive appropriate care and treatment, might befavorable to allocate and make use of ICU critical care resources rationally. It isworthy of clinical application.