title: A Protocolised Once a Day Modified Early Warning Score (MEWS) Measurement Is an Appropriate Screening Tool for Major Adverse Events in a General Hospital Population.
abstract: BACKGROUND
  The Modified Early Warning Score (MEWS) was developed to timely recognise clinically deteriorating hospitalised patients. However, the ability of the MEWS in predicting serious adverse events (SAEs) in a general hospital population has not been examined prospectively. The aims were to (1) analyse protocol adherence to a MEWS protocol in a real-life setting and (2) to determine the predictive value of protocolised daily MEWS measurement on SAEs: death, cardiac arrests, ICU-admissions and readmissions.
  
  
  METHODS
  All adult patients admitted to 6 hospital wards in October and November 2015 were included. MEWS were checked each morning by the research team. For each critical score (MEWS ≥ 3), the clinical staff was inquired about the actions performed. 30-day follow-up for SAEs was performed to compare between patients with and without a critical score.
  
  
  RESULTS
  1053 patients with 3673 vital parameter measurements were included, 200 (19.0%) had a critical score. The protocol adherence was 89.0%. 18.2% of MEWS were calculated wrongly. Patients with critical scores had significant higher rates of unplanned ICU admissions [7.0% vs 1.3%, p < 0.001], in-hospital mortality [6.0% vs 0.8%, p < 0.001], 30-day readmission rates [18.6% vs 10.8%, p < 0.05], and a longer length of stay [15.65 (SD: 15.7 days) vs 6.09 (SD: 6.9), p < 0.001]. Specificity of MEWS related to composite adverse events was 83% with a negative predicting value of 98.1%.
  
  
  CONCLUSIONS
  Protocol adherence was high, even though one-third of the critical scores were calculated wrongly. Patients with a MEWS ≥ 3 experienced significantly more adverse events. The negative predictive value of early morning MEWS < 3 was 98.1%, indicating the reliability of this score as a screening tool.
authors: Department of Internal Medicine, Section Acute Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors: Louise S
authors: LS
authors: van Galen
authors: Department of Internal Medicine, Section Acute Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors: Casper C
authors: CC
authors: Dijkstra
authors: Department of Anaesthesiology, Academic Medical Center, Amsterdam, the Netherlands.
authors: Jeroen
authors: J
authors: Ludikhuize
authors: Department of Internal Medicine, Section Acute Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors: Mark H H
authors: MH
authors: Kramer
authors: Department of Internal Medicine, Section Acute Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors: Prabath W B
authors: http://orcid.org/0000-0002-1555-3682
authors: PW
authors: Nanayakkara
mesh_terms: D000368:Aged; D016638:Critical Illness / Q000401:mortality*; D004282:Documentation / Q000592:standards* / Q000706:statistics & numerical data; D042241:Early Diagnosis; D005260:Female; D006305:Health Status Indicators; D017052:Hospital Mortality; D006769:Hospitals, General; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index