BACKGROUND Severe symptoms associated with sepsis syndrome(SS)are considered a severe threat,which not only increases therapeutic difficulty but also causes a prognostic mortality rate.However,at present,few related s...BACKGROUND Severe symptoms associated with sepsis syndrome(SS)are considered a severe threat,which not only increases therapeutic difficulty but also causes a prognostic mortality rate.However,at present,few related studies focused on the application of different score scales for disease and prognosis assessment in liver cirrhosis(LC)complicated with SS.AIM To determine the correlations of the model for end-stage liver disease(MELD),sequential organ failure assessment(SOFA),and modified early warning score(MEWS)points with the prognosis of patients with LC complicated with SS.METHODS This retrospective analysis included 426 LC cases from February 2019 to April 2022.Of them,225 cases that were complicated with SS were assigned to the LC+SS group,and 201 simple LC cases were included in the LC group.Intergroup differences in MELD,SOFA,and MEWS scores were compared,as well as their diagnostic value for LC+SS.The correlations of the three scores with the progno-sis of patients with LC+SS were further analyzed,as well as the related risk factors affecting patients’outcomes,after the follow-up investigation.RESULTS MELD,SOFA,and MEWS scores were all higher in the LC+SS group vs the LC group,and their combined assessment for LC+SS revealed a diagnostic sensi-tivity and a specificity of 89.66%and 90.84%,respectively(P<0.05).The LC+SS group reported 58 deaths,with an overall mortality rate of 25.78%.Deceased pa-tients presented higher MELD,SOFA,and MEWS points than those who survived(P<0.05).MELD,SOFA,and MEWS scores were determined by COX analysis as factors independently affecting the prognosis of patients with LC+SS(P<0.05).CONCLUSION MELD,SOFA,and MEWS effectively diagnosed LC in patients complicated with SS,and they demonstrated great significance in assessing prognosis,which provides a reliable prognosis guarantee for patients with LC+SS.However,their assessment effects remain limited,which is worthy of further investigation by more in-depth and rigorous experimental analysis.展开更多
Objective:To explore the application and effectiveness of the Modified Early Warning Score(MEWS)in emergency triage and evaluate its impact on triage efficiency and accuracy.Methods:A total of 6,000 patients who visit...Objective:To explore the application and effectiveness of the Modified Early Warning Score(MEWS)in emergency triage and evaluate its impact on triage efficiency and accuracy.Methods:A total of 6,000 patients who visited the emergency department between February 2023 and July 2024 were selected and randomly divided into the observation group and the control group,with 3,000 patients in each group.The observation group used MEWS for triage,while the control group adopted the traditional experience-based triage method.The triage time and accuracy were recorded and compared between the two groups.Results:The triage time of the observation group was significantly shorter than that of the control group(0.84±0.21 min vs.1.42±0.35 min,t=6.54,P<0.01).The triage accuracy of the observation group was 98.67%(2,960/3,000),significantly higher than the control group’s 93.33%(2,800/3,000,χ²=5.95,P<0.05).Conclusion:MEWS significantly improves triage efficiency and accuracy in emergency triage,providing an effective tool for optimizing emergency resource allocation,reducing patient wait times,and ensuring patient safety.It has high clinical application value.Further research is needed to validate its effectiveness in multi-center and large-sample studies and to explore its integration with intelligent technologies.展开更多
BACKGROUND:This study was undertaken to validate the use of the modified early warning score(MEWS) as a predictor of patient mortality and intensive care unit(ICU)/ high dependency(HD)admission in an Asian population....BACKGROUND:This study was undertaken to validate the use of the modified early warning score(MEWS) as a predictor of patient mortality and intensive care unit(ICU)/ high dependency(HD)admission in an Asian population.METHODS:The MEWS was applied to a retrospective cohort of 1 024 critically ill patients presenting to a large Asian tertiary emergency department(ED) between November 2006 and December2007.Individual MEWS was calculated based on vital signs parameters on arrival at ED.Outcomes of mortality and ICU/HD admission were obtained from hospital records.The ability of the composite MEWS and its individual components to predict mortality within 30 days from ED visit was assessed.Sensitivity,specificity,positive and negative predictive values were derived and compared with values from other cohorts.A MEWS of ≥4 was chosen as the cut-off value for poor prognosis based on previous studies.RESULTS:A total of 311(30.4%) critically ill patients were presented with a MEWS ≥4.Their mean age was 61.4 years(SD 18.1) with a male to female ratio of 1.10.Of the 311 patients,53(17%)died within 30 days,64(20.6%) were admitted to ICU and 86(27.7%) were admitted to HD.The area under the receiver operating characteristic curve was 0.71 with a sensitivity of 53.0%and a specificity of 72.1%in addition to a positive predictive value(PPV) of 17.0%and a negative predictive value(NPV)of 93.4%(MEWS cut-off of ≥4) for predicting mortality.CONCLUSION:The composite MEWS did not perform well in predicting poor patient outcomes for critically ill patients presenting to an ED.展开更多
Purpose： Recording vital signs is important in the hospital setting and the quality of this documentation influences clinical decision making. The Modified Early Warning Score （MEWS） uses vital signs to categorise ...Purpose： Recording vital signs is important in the hospital setting and the quality of this documentation influences clinical decision making. The Modified Early Warning Score （MEWS） uses vital signs to categorise the severity of a patient＇s physiological derangement and illustrates the clinical impact of vital signs in detecting patient deterioration and making management decisions. This descriptive study measured the quality of vital sign recordings in an acute care trauma setting, and used the MEWS to determine the impact the documentation quality had on the detection of physiological derangements and thus, clinical decision making. Methods： Vital signs recorded by the nursing staff of all trauma patients in the acute care trauma wards at a regional hospital in South Africa were collected from January 2013 to February 2013. Investigator- measured values taken within 2 hours of the routine observations and baseline patient information were also recorded. A MEWS for each patient was calculated from the routine and investigator-measured observations. Basic descriptive statistics were performed using EXCEL Results： The details of lgl newly admitted patients were collected. Completion of recordings was 81% for heart rate, 88~; for respiratory rate, 98~; for blood pressure, 92% for temperature and 41~ for GCS. The recorded heart rate was positively correlated with the investigator＇s measurement （Pearson＇s correlation coefficient of 0.76）; while the respiratory rate did not correlate （Pearson＇s correlation coefficient of 0.02）. In 59~ of patients the recorded respiratory rate （RR） was exactly 20 breaths per minute and 27~ had a recorded RR of exactly 15. Seven percent of patients had aberrant Glasgow Coma Scale readings above the maximum value of 15. The average MEWS was 2 for both the recorded （MEWS（R）） and investigator （MEWS（1）） vitals, with the range of MEWS（R） 0-7 and MEWS（1） 0-9. Analysis showed 59% of the MEWS（R） underestimated the physiological derangement （scores were lower than the MEWS（1））; 80%; of patients had a MEWS（R） requiring 4 hourly checks which was only completed in 2%;; 86% of patients had a MEWS（R） of less than three （i.e. not necessitating escalation of care）, but 33% of these showed a MEWS（1） greater than three （i.e. actually necessitating escalation of care）. Conclusion： Documentation of vital signs aids management decisions, indicating the physiological derangement of a patient and dictating treatment. This study showed that there was a poor quality of vital sign recording in this acute care trauma setting, which led to underestimation of patients＇ physi- ological derangement and an inability to detect deteriorating patients. The MEWS could be a powerful tool to empower nurses to become involved in the diagnosis and detection of deteriorating patients, as well as providing a framework to communicate the severity of derangement between health workers. However, it requires a number of strategies to improve the quality of vital sign recording, including continuing education, increasing the numbers of competent staff and administrative changes in vital sign charts.展开更多
文摘BACKGROUND Severe symptoms associated with sepsis syndrome(SS)are considered a severe threat,which not only increases therapeutic difficulty but also causes a prognostic mortality rate.However,at present,few related studies focused on the application of different score scales for disease and prognosis assessment in liver cirrhosis(LC)complicated with SS.AIM To determine the correlations of the model for end-stage liver disease(MELD),sequential organ failure assessment(SOFA),and modified early warning score(MEWS)points with the prognosis of patients with LC complicated with SS.METHODS This retrospective analysis included 426 LC cases from February 2019 to April 2022.Of them,225 cases that were complicated with SS were assigned to the LC+SS group,and 201 simple LC cases were included in the LC group.Intergroup differences in MELD,SOFA,and MEWS scores were compared,as well as their diagnostic value for LC+SS.The correlations of the three scores with the progno-sis of patients with LC+SS were further analyzed,as well as the related risk factors affecting patients’outcomes,after the follow-up investigation.RESULTS MELD,SOFA,and MEWS scores were all higher in the LC+SS group vs the LC group,and their combined assessment for LC+SS revealed a diagnostic sensi-tivity and a specificity of 89.66%and 90.84%,respectively(P<0.05).The LC+SS group reported 58 deaths,with an overall mortality rate of 25.78%.Deceased pa-tients presented higher MELD,SOFA,and MEWS points than those who survived(P<0.05).MELD,SOFA,and MEWS scores were determined by COX analysis as factors independently affecting the prognosis of patients with LC+SS(P<0.05).CONCLUSION MELD,SOFA,and MEWS effectively diagnosed LC in patients complicated with SS,and they demonstrated great significance in assessing prognosis,which provides a reliable prognosis guarantee for patients with LC+SS.However,their assessment effects remain limited,which is worthy of further investigation by more in-depth and rigorous experimental analysis.
文摘Objective:To explore the application and effectiveness of the Modified Early Warning Score(MEWS)in emergency triage and evaluate its impact on triage efficiency and accuracy.Methods:A total of 6,000 patients who visited the emergency department between February 2023 and July 2024 were selected and randomly divided into the observation group and the control group,with 3,000 patients in each group.The observation group used MEWS for triage,while the control group adopted the traditional experience-based triage method.The triage time and accuracy were recorded and compared between the two groups.Results:The triage time of the observation group was significantly shorter than that of the control group(0.84±0.21 min vs.1.42±0.35 min,t=6.54,P<0.01).The triage accuracy of the observation group was 98.67%(2,960/3,000),significantly higher than the control group’s 93.33%(2,800/3,000,χ²=5.95,P<0.05).Conclusion:MEWS significantly improves triage efficiency and accuracy in emergency triage,providing an effective tool for optimizing emergency resource allocation,reducing patient wait times,and ensuring patient safety.It has high clinical application value.Further research is needed to validate its effectiveness in multi-center and large-sample studies and to explore its integration with intelligent technologies.
基金supported by grants from SingHealth Talent Development Fund,Singapore(TDF/CS001/2006)InfoComm Research Cluster,Nanyang Technological University,Singapore(2006ICT09)
文摘BACKGROUND:This study was undertaken to validate the use of the modified early warning score(MEWS) as a predictor of patient mortality and intensive care unit(ICU)/ high dependency(HD)admission in an Asian population.METHODS:The MEWS was applied to a retrospective cohort of 1 024 critically ill patients presenting to a large Asian tertiary emergency department(ED) between November 2006 and December2007.Individual MEWS was calculated based on vital signs parameters on arrival at ED.Outcomes of mortality and ICU/HD admission were obtained from hospital records.The ability of the composite MEWS and its individual components to predict mortality within 30 days from ED visit was assessed.Sensitivity,specificity,positive and negative predictive values were derived and compared with values from other cohorts.A MEWS of ≥4 was chosen as the cut-off value for poor prognosis based on previous studies.RESULTS:A total of 311(30.4%) critically ill patients were presented with a MEWS ≥4.Their mean age was 61.4 years(SD 18.1) with a male to female ratio of 1.10.Of the 311 patients,53(17%)died within 30 days,64(20.6%) were admitted to ICU and 86(27.7%) were admitted to HD.The area under the receiver operating characteristic curve was 0.71 with a sensitivity of 53.0%and a specificity of 72.1%in addition to a positive predictive value(PPV) of 17.0%and a negative predictive value(NPV)of 93.4%(MEWS cut-off of ≥4) for predicting mortality.CONCLUSION:The composite MEWS did not perform well in predicting poor patient outcomes for critically ill patients presenting to an ED.
文摘Purpose： Recording vital signs is important in the hospital setting and the quality of this documentation influences clinical decision making. The Modified Early Warning Score （MEWS） uses vital signs to categorise the severity of a patient＇s physiological derangement and illustrates the clinical impact of vital signs in detecting patient deterioration and making management decisions. This descriptive study measured the quality of vital sign recordings in an acute care trauma setting, and used the MEWS to determine the impact the documentation quality had on the detection of physiological derangements and thus, clinical decision making. Methods： Vital signs recorded by the nursing staff of all trauma patients in the acute care trauma wards at a regional hospital in South Africa were collected from January 2013 to February 2013. Investigator- measured values taken within 2 hours of the routine observations and baseline patient information were also recorded. A MEWS for each patient was calculated from the routine and investigator-measured observations. Basic descriptive statistics were performed using EXCEL Results： The details of lgl newly admitted patients were collected. Completion of recordings was 81% for heart rate, 88~; for respiratory rate, 98~; for blood pressure, 92% for temperature and 41~ for GCS. The recorded heart rate was positively correlated with the investigator＇s measurement （Pearson＇s correlation coefficient of 0.76）; while the respiratory rate did not correlate （Pearson＇s correlation coefficient of 0.02）. In 59~ of patients the recorded respiratory rate （RR） was exactly 20 breaths per minute and 27~ had a recorded RR of exactly 15. Seven percent of patients had aberrant Glasgow Coma Scale readings above the maximum value of 15. The average MEWS was 2 for both the recorded （MEWS（R）） and investigator （MEWS（1）） vitals, with the range of MEWS（R） 0-7 and MEWS（1） 0-9. Analysis showed 59% of the MEWS（R） underestimated the physiological derangement （scores were lower than the MEWS（1））; 80%; of patients had a MEWS（R） requiring 4 hourly checks which was only completed in 2%;; 86% of patients had a MEWS（R） of less than three （i.e. not necessitating escalation of care）, but 33% of these showed a MEWS（1） greater than three （i.e. actually necessitating escalation of care）. Conclusion： Documentation of vital signs aids management decisions, indicating the physiological derangement of a patient and dictating treatment. This study showed that there was a poor quality of vital sign recording in this acute care trauma setting, which led to underestimation of patients＇ physi- ological derangement and an inability to detect deteriorating patients. The MEWS could be a powerful tool to empower nurses to become involved in the diagnosis and detection of deteriorating patients, as well as providing a framework to communicate the severity of derangement between health workers. However, it requires a number of strategies to improve the quality of vital sign recording, including continuing education, increasing the numbers of competent staff and administrative changes in vital sign charts.
