title: The use of Modified Early Warning Score may help anesthesists in postoperative level of care selection in emergency abdominal surgery.
abstract: BACKGROUND
  The Modified Early Warning Score (MEWS) was proposed for early identification of patients deterioration. The purpose of this study was to determine if MEWS calculation can help the anaesthesist select the correct level of care to avoid inappropriate admission to the ICU and to enhance the use of the High Dependency Unit (HDU) after emergency surgical procedures.
  
  
  METHODS
  Emergency surgical patients admitted before MEWS application (Jan 2008-Mar 2009) were included in the control group, whereas emergency surgical patients after MEWS introduction constituted the intervention group (Apr 2009-Jan 2010). Admission diagnosis was included into three groups for data analysis: acute abdomen (intestinal occlusion, bowel perforation, intestinal ischemia), non-complicated surgery (hernia recurrence, cholecystitis, appendicitis), and blunt abdominal trauma. In intervention group, MEWS was calculated by the anaesthesists on duty before and after surgical procedure. Patients with a MEWS of 3 or 4 were transferred to the HDU, whereas a MEWS score of 5 or more was considered criteria for ICU admission.
  
  
  RESULTS
  A total of 1082 patients were enrolled in this study. The control group was made up of 604 patients, whereas the MEWS group included 478 patients. Baseline and clinical status were comparable between groups. After MEWS introduction, HDU admissions significantly increased from 14% to 21% (P=0.0008), with a significant decrease of ICU admissions (from 11% to 5%; P=0.0010). Mortality rate analysis did not differ between groups.
  
  
  CONCLUSIONS
  This study suggests that the use of a simple and reproducible score system may help in reducing ICU admissions after emergency surgery.
authors.affiliation: Anesthesia and Intensive Care Unit of Emergency Department, Careggi Teaching Hospital, Florence, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Peris
authors.forename: G
authors.initials: G
authors.lastname: Zagli
authors.forename: N
authors.initials: N
authors.lastname: Maccarrone
authors.forename: S
authors.initials: S
authors.lastname: Batacchi
authors.forename: R
authors.initials: R
authors.lastname: Cammelli
authors.forename: A
authors.initials: A
authors.lastname: Cecchi
authors.forename: L
authors.initials: L
authors.lastname: Perretta
authors.forename: P
authors.initials: P
authors.lastname: Bechi
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000006:Abdomen, Acute / Q000601:surgery; D000007:Abdominal Injuries / Q000601:surgery; D000368:Aged; D000776:Anesthesiology / Q000379:methods*; D001064:Appendicitis / Q000601:surgery; D001794:Blood Pressure; D002764:Cholecystitis / Q000601:surgery; D003422:Critical Care / Q000379:methods*; D004630:Emergencies; D005260:Female; D006339:Heart Rate; D059685:Herniorrhaphy; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D010343:Patient Admission / Q000592:standards*; D018579:Patient Selection; D019095:Point-of-Care Systems; D011997:Recovery Room / Q000706:statistics & numerical data; D012086:Reoperation; D056152:Respiratory Rate; D012720:Severity of Illness Index; D013696:Temperature