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Q J Med 2001; 94: 521-526
© 2001 Association of Physicians

Validation of a modified Early Warning Score in medical admissions

C.P. Subbe, M. Kruger1, P. Rutherford2 and L. Gemmel1

From the Departments of Medicine, and 1 Critical Care, Wrexham Maelor Hospital, and 2 Department of Nephrology, University of Wales College of Medicine, Wrexham, UK

Received 17 May 2001 and in revised form 9 July 2001

The Early Warning Score (EWS) is a simple physiological scoring system suitable for bedside application. The ability of a modified Early Warning Score (MEWS) to identify medical patients at risk of catastrophic deterioration in a busy clinical area was investigated. In a prospective cohort study, we applied MEWS to patients admitted to the 56-bed acute Medical Admissions Unit (MAU) of a District General Hospital (DGH). Data on 709 medical emergency admissions were collected during March 2000. Main outcome measures were death, intensive care unit (ICU) admission, high dependency unit (HDU) admission, cardiac arrest, survival and hospital discharge at 60 days. Scores of 5 or more were associated with increased risk of death (OR 5.4, 95%CI 2.8–10.7), ICU admission (OR 10.9, 95%CI 2.2–55.6) and HDU admission (OR 3.3, 95%CI 1.2–9.2). MEWS can be applied easily in a DGH medical admission unit, and identifies patients at risk of deterioration who require increased levels of care in the HDU or ICU. A clinical pathway could be created, using nurse practitioners and/or critical care physicians, to respond to high scores and intervene with appropriate changes in clinical management.

Address correspondence to Dr C.P. Subbe, 77 Brook Lane, Chester CH2 2EE


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