Study On The Application Value Of Modified Early Warning Score In General Wards

BackgroundModified early warning score(MEWS)is a condition assessment tool including temperature,heart rate,respiration,systolic blood pressure and consciousness.It can effectively identify "potentially critical" patients and reduce the occurrence of adverse events by early and objective assessment of patients' conditions.The National health service(NHS)in the UK recommends MEWS as a tool for condition assessment.However,at present,most research on MEWS focuses on emergency and Intensive care unit(ICU),while there are few studies on MEWS in general wards,and its application value remains to be explored.ObjectiveThrough the retrospective analysis of the application effect of MEWS in general wards,the application value of MEWS in general wards was determined,and the best cutoff value of MEWS in general wards was explored.Method1.Delphi expert consultation method to determine the end point events:The types of end point events were determined by literature retrieval,and the medical advice of patients in general wards was collected as the contents of the end point events item pool.The Delphi method is used to filter,classify and define end point events.2.Diagnostic test of MEWS in general wards:The convenience sampling method was used to select patients who were hospitalized for four days from 10:00am on February 24,2019 to 10:00am on February 28,2019 in a Third-class hospital in Shenzhen,Guangdong Province.By looking up the electronic medical records and nursing records,review the maximum value of MEWS of the study subjects every day(10:00am-10:00am of the next day as the time period),and obtain whether the patients in the corresponding time period of MEWS occurring end point events.According to whether the end point events occurred,the patients were divided into two groups:the occurrence group and the non occurrence group.To compare whether there was a statistical difference in MEWS between the two groups.Review the prediction results of the highest value of MEWS on the end point events,compare the actual occurrence of the end point events(gold standard),and carry out diagnostic tests.Draw the Receiver operating characteristic curve(ROC)of the end point events predicted by MEWS,and use the Area under curve(AUC)to evaluate the application value of MEWS in general wards.Result1.29 end point events were identified by Delphi expert consultation method,including 6 potential events,10 critical events and 13 endangered events.The positive coefficient of experts in the two rounds was 100.00%,93.33%,the authority coefficient of experts was 0.73?1.00,and the coordination degree of experts was 0.372 and 0.374 respectively.2.650 inpatients in general wards were included in the study.The highest value of MEWS was recorded every day for four days.2600 times of the highest value of MEWS were collected.MEWS scored 1,with the largest number of people(2199/84.58%).The end point events were recorded every day for four days.The results showed that the end point events occurred for 187 cases,99 potential events,67 critical events and 21 endangered events.3.There was significant difference in MEWS between patients occurrence and non occurrence end point events(P?0.001),there was significant difference between patients occurrence and non occurrence potential events,critical events,and endangered events(P?0.001).4.The correlation coefficient between MEWS and end point events was 0.312,indicating that there was a low degree positive correlation between MEWS and the end point events(P?0.001);the correlation coefficients between MEWS and the potential event,critical event,endangered event were 0.195,0.224 and 0.089 respectively,indicating that there was no correlation between MEWS and the potential events,critical events,endangered events(P?0.001).5.When the cutoff value of MEWS is 2,it has the best prediction effect on the end point events of general wards,AUC of MEWS in predicting the end point events in general wards was 0.672,the sensitivity was 45.45%,and the specificity was 86.90%;The AUC of predicting potential events,critical events and endangered events was 0.626,0.719 and 0.669 respectively,with sensitivity of 38.38%,55.22%and 47.62%respectively,and specificity of 85.49%,85.63%and 84.84%respectively.6.The AUC of MEWS in predicting the end point events in surgical wards and non-surgical wards was 0.704 and 0.639,respectively;The AUC for predicting potential events was 0.585 and 0.670,the AUC for predicting critical events was 0.826 and 0.661,and the AUC for predicting endangered events was 0.574 and 0.808,respectively.ConclusionThe condition of inpatients in general wards is relatively stable,and patients with MEWS score of 1 account for more.When the cutoff value of MEWS is 2,it has the best prediction effect on the end point events of inpatients in general wards.However,the prediction efficiency of MEWS for end point events is insufficient,among which the prediction efficiency for potential events,critical events and endangered events are all low,so the application value of MEWS in general wards is insufficient.In order to apply MEWS to the general wards,it is necessary to adjust the interval assignment of evaluation indexes and combine other indexes such as pain,diastolic pressure,age,oxygen saturation of blood,etc.to improve the prediction effect of MEWS on the end point events of inpatients in the general wards.