126 Acute Medicine 2011; 10(3): 126-132 Research, Audit and Clinical Practice 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 hospital- stay and adverse outcomes. A combined scoring system improved the sensitivity of prediction. Keywords MEWS; Biochemical parameters; Acute Medical Admissions; Prediction of outcomes. Background Patients admitted to hospitals are liable to sudden deterioration in their clinical condition, which sometimes results in unexpected morbidity and mortality. 1,2 Catastrophic deterioration of patients in hospital is frequently preceded by documented deterioration of physiological parameters. 3-5 Clinicians have developed scoring systems to facilitate detection of potentially serious patients in a ward setting. The Acute Physiology and Chronic Health Evaluation (APACHE) II Score, 6 Mortality Probability Model (MPM) 7 and The Simplified Acute Physiology Score (SAPS) 8 were thus developed with the aim of predicting such deteriorations. However most of these scoring systems were developed and validated on subgroups involving mainly surgical patients, limiting their utility as bedside assessment tools in general acute medical admissions. 9 The Modified Early Warning Score (MEWS) is a track and trigger scoring system based on simple routine bedside physiological observations. 10-12 MEWS was originally developed with the aim of facilitating timely recognition of patients with established or impending critical illness and to empower nurses and junior medical staff to secure experienced help through the operation of a trigger threshold which, if reached, requires mandatory attendance by a more senior member of staff. 11 However, there are conflicting data on the applicability of MEWS to undifferentiated medical patients admitted to an AMU setting. One study demonstrated no relationship between MEWS score and in-hospital deaths, while another has reported correlations with mortality and length of stay. 12,13 Studies have also looked at the possibility of using markers of acute and chronic disease to assess prognosis in comparison with the use of MEWS to see if either offers benefits to clinical practice. 14-17 A raised CRP generally suggests an acute infective or inf lammatory process, while a low albumin is most The value of the Modified Early Warning Score and biochemical parameters as predictors of patient outcome in acute medical admissions: a prospective study YS Perera, P Ranasinghe, AMMC Adikari, WDTS Welivita, WME Perera, WMDR Wijesundara, SAAP Karunanayake & GR Constantine Yashasvi Sanja Perera (MBBS) Research Assistant, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Sri Lanka Email: yashas2004@yahoo .com Priyanga Ranasinghe (MBBS) Research Associate, Diabetes Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Sri Lanka Email: rana90210@yahoo. com Adikari Mudiyanselage Madura Chinthana Adikari (MBBS) Research Assistant, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Sri Lanka Email: maduranew@yahoo. com Welivitage Don Thilina Sampath Welivita Faculty of Medicine, University of Colombo, Sri Lanka Email: thilinawelivita@ gmail.com Wickramage Malith Eranda Perera Faculty of Medicine, University of Colombo, Sri Lanka Email: malith_e@yahoo. co.uk Wijesundara Mudiyanselage Dileepa Roshan Wijesundara Faculty of Medicine, University of Colombo, Sri Lanka Email: dileepa_roshan@ yahoo.com Sembukutti Arachchige Ajith Panduka Karunanayake (MBBS, MD,MRCP) Senior Lecturer in Clinical Medicine Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Sri Lanka Email: pandukaru@mail. com Godwin Roger Constantine (MBBS, MD) Senior Lecturer in Clinical Medicine Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Sri Lanka Email: godwinconstantine@live.com Correspondence: Yashasvi Sanja Perera (MBBS) Research Assistant, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Sri Lanka Email: yashas2004@yahoo.com © 2011 Rila Publications Ltd. Key Points • The Modified Early Warning Score (MEWS), helps to recognize patients with established/impending critical illness. • MEWS is a simple bedside tool that can be used by nursing staff in an busy clinical area. • The study evaluates effectiveness of MEWS and biochemical parameters in a acute medical setting • Those with a higher MEWS had a higher chance of reaching adverse end points • MEWS was not predictive of length of hospital stay • Biochemical parameters were better than physiological parameters in predicting length of hospital stay and the probability of reaching adverse outcomes • Incorporating a score for biochemical parameters improved the sensitivity of the model for prediction of adverse outcomes. Acute Medicine V10 N3:Acute Med V10 N3 8/30/2011 4:07 PM Page 126