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Lee and Choi: Validation of a Modified Early Warning Score to Predict ICU Transfer for Patients with Severe Sepsis or Septic Shock on General Wards
Original Article

Journal of Korean Academy of Nursing 2014; 44(2): 219-227.

Published online: 30 April 2014

DOI: https://doi.org/10.4040/jkan.2014.44.2.219

Validation of a Modified Early Warning Score to Predict ICU Transfer for Patients with Severe Sepsis or Septic Shock on General Wards

Ju Ry Lee1, Hye Ran Choi2

1Medical Alert Team, Asan Medical Center, Seoul, Korea.

2College of Medicine, University of Ulsan, Seoul, Korea.

Address reprint requests to: Choi, Hye Ran. Department of Clinical Nursing, College of Medicine, University of Ulsan, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul 138-736, Korea. Tel: +82-2-3010-5334, Fax: +82-2-3010-5332, reniechoi@hanmail.net

Received 4 December 2013       Revised 16 December 2013       Accepted 31 March 2014

© 2014 Korean Society of Nursing Science

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0/) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

To assess whether the Modified Early Warning Score (MEWS) predicts the need for intensive care unit (ICU) transfer for patients with severe sepsis or septic shock admitted to general wards.

Methods

A retrospective chart review of 100 general ward patients with severe sepsis or septic shock was implemented. Clinical information and MEWS according to point of time between ICU group and general ward group were reviewed. Data were analyzed using multivariate logistic regression and the area under the receiver operating characteristic curves with SPSS/WIN 18.0 program.

Results

Thirty-eight ICU patients and sixty-two general ward patients were included. In multivariate logistic regression, MEWS (odds ratio [OR] 2.02, 95% confidence interval [CI] 1.43-2.85), lactic acid (OR 1.83, 95% CI 1.22-2.73) and diastolic blood pressure (OR 0.89, 95% CI 0.80-1.00) were predictive of ICU transfer. The sensitivity and the specificity of MEWS used with cut-off value of six were 89.5% and 67.7% for ICU transfer.

Conclusion

MEWS is an effective predictor of ICU transfer. A clinical algorithm could be created to respond to high MEWS and intervene with appropriate changes in clinical management.

Keywords: Hospital rapid response team, Sepsis, Septic shock, Modified early warning score, Intensive care unit

Figures and Tables

Figure 1
Receiver operator characteristic curve for ability to predict ICU admission. A point is cut-off value of 5 (sensitivity 94.7% and specificity 50.0%), B point is cut-off value of 6 (sensitivity 82.5% and specificity 80.5%), and C point is cut-off value of 7 (sensitivity 64.0% and specificity 87.5%).
jkan-44-219-g001
Table 1
Modified Early Warning Score
jkan-44-219-i001

AVPU=Alert, verbal, pain, unresponsive.

Table 2
Baseline Characteristics of Sample
jkan-44-219-i002

*Yates' correction; †Fisher's exact test; M (IQR)=Median (Interquartile range); ICU=Intensive care unit; APACHE=Acute physiology and chronic health evaluation.

Table 3
Physiological Parameters and MEWS Dichotomized according to Point of Time
jkan-44-219-i003

*Zero point=Systolic blood pressure<90 mmHg at first measurement; ICU=Intensive care unit; Median (IQR)=Median (Interquartile range); SBP=Systolic blood pressure; DBP=Diastolic blood pressure; HR=Heart rate; RR=Respiratory rate; bpm=breaths per minute; BT=Body temperature; GCS=Glasgow coma scale; MEWS=Modified early warning score.

Table 4
Logistic Regression Analysis for ICU Transfer
jkan-44-219-i004

*Zero point=Systolic blood pressure<90 mmHg at first measurement; ICU=Intensive care unit; MET=Medical emergency team; OR=Odds ratio; CI=Confidence interval; SBP=Systolic blood pressure; DBP=Diastolic blood pressure; HR=Heart rate; RR=Respiratory rate; bpm=breaths per minute; GCS=Glasgow coma scale; MEWS=Modified early warning score; APACHE=Acute physiology and chronic health evaluation.

Notes

This manuscript is a revision of the first author's master's thesis from University of Ulsan.

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