Abstract

We evaluated the effectiveness of MEWS and biochemical parameters in predicting outcomes for acute medical admissions. Data from consecutive admissions to the Acute Medical Unit (AMU) of National Hospital of Sri Lanka were collected. C-reactive protein (CRP), albumin, white cell count, platelet count and haemoglobin values were collected. Adverse endpoints were HDU/ICU admission, cardio-respiratory emergency/resuscitation and death.

A MEWS score of >=5 together with increasing age, pulse rate, respiratory rate, AVPU score, CRP, CRP/Albumin ratio and reduced platelet and albumin level all increased the odds of reaching ‘adverse endpoints”. Adding a score for biochemical parameters increased the area under the ROC curve for reaching “adverse endpoints’. Biochemical parameters better predicted length of hospitalstay and adverse outcomes. A combined scoring system improved the sensitivity of prediction.

[download-attachments container="div" style="list" display_icon="1" display_count="1" display__size="0"]

References

1. Hillman KM, Bristow PJ, Chey T, et al. Antecedents to Hospital Deaths. Internal Medicine Journal 2001; 31(6): 343-8.
2. Smith GB, Prytherch DR, Schmidt P, et al. Hospital-wide Physiological Surveillance-A new approach to the early identification and management of the sick patient. Resuscitation 2006; 71: 19-28.
3. Goldhill DR, McNarry AF, Mandersloot G, et al. A physiologically-based early warning score for ward patients: the association between score and outcome. Anaesthesia 2005; 60: 547–53.
4. Watkinson PJ, Barber VS, Price JD, et al. A randomised controlled trial of the effect of continuous electronic physiological monitoring on the adverse event rate in high risk medical and surgical patients. Anaesthesia 2006; 61: 1031–9.
5. Smith AF, Wood J; Can some in-hospital cardio-respiratory arrests be prevented? A prospective survey. Resuscitation 1998; 37: 133–137.
6. Lujano-Nicolás LA, Pérez-Hernández JL, Durán-Pérez EG, et al. Corelation among clinical, biochemical and tomographic criteria in order to evaluate the severity in acute pancreatitis. Revista española de enfermedades digestivas 2010; 102(6): 376-80.
7. Higgins TL, Teres D, Copes WS, et al. Assessing contemporary intensive care unit outcome: an updated Mortality Probability Admission Model (MPM0-III). Critical Care Medicine 2007; 35(3): 827-35.
8. Shadnia S, Mehrpour O, Soltaninejad K. A simplified acute physiology score in the prediction of acute aluminum phosphide poisoning outcome. Indian Journal of Medical Sciences 2010; 64(12): 532-9.
9. Bein T, Unertl K. [Potentialities and limitations of the score system in intensive medicine]. Anasthesiol Intensivmed Notfallmed Schmerzther 1993; 28(8): 476-83.
10. Armagan E, Yilmaz Y, Olmez OF, et al. Predictive value of the modified Early Warning Score in a Turkish emergency department. European Journal of Emergency Medicine 2008; 15(6): 338-40.
11. Morgan RJM, Williams F, Wright MM; An Early Warning Scoring System for detecting developing critical illness. Clinical Intensive Care 1997; 8: 100.
12. Subbe CP, Kruger M, Rutherford P, et al. Validation of a modified early warning score in medical admissions. Quarterly Journal of Medicine 2001; 94: 521-526.
13. Subbe CP, Davies RG, Williams E, et al. Effect of introducing the modified early warning score on clinical outcomes, cardiopulmonary arrests and intensive care utilisation in acute medical admissions. Anaesthesia 2003; 58: 775-803.
14. Fairclough E, Cairns E, Hamilton J, et al. Evaluation of a modified early warning system for acute medical admissions and comparison with Creactive protein/albumin ratio as a predictor of patient outcome. Clinical Medicine 2009; 9(1): 30-33.
15. Iwata M, Kuzuya M, Kitagawa Y, et al. Prognostic value of serum albumin combined with serum C-reactive protein levels in older hospitalized patients: continuing importance of serum albumin. Aging Clinical and Experimental Research 2006; 18(4): 307-11.
16. Kompoti M, Drimis S, Papadaki A, et al. Serum C-reactive protein at admission predicts in-hospital mortality in medical patients. European Journal of Internal Medicine 2008; 19(4): 261-5.
17. Prieto MF, Kilstein J, Bagilet D, et al. [C-reactive protein as a marker of mortality in intensive care unit]. Medicina Intensiva 2008; 32(9): 424-30.
18. Clyne B, Olshaker JS. The C-reactive protein. Journal of Emergency Medicine 1999; 17(6): 1019-25.
19. Lyons O, Whelan B, Bennett K, et al. Serum albumin as an outcome predictor in hospital emergency medical admissions. European Journal of Internal Medicine 2010; 21(1): 17-20.
20. Ministry of Health Care and Nutrition, Sri Lanka. Health Institutions by Type - Year 2009. Available from URL;http://203.94.76.60/nihs/BEDS/2009%20Total%20Beds.pdf (accessed 20/08/2010).
21. National Institute for Health and Clinical Excellence; Acutely ill patients in hospital: recognition of and response to acute illness in adults in hospital. London: NICE, 2007:1-8.
22. Matthai WH Jr. Evaluation of thrombocytopenia in the acute coronary syndrome. Current Opinion in Hematology 2010; 17(5): 398-404.