Predictive Value of the Modified Early Warning Score in a Turkish Emergency Department

Objective: The modified Early Warning Score (mEWS) is a triage instrument that promises to predict patient disposition and clinical outcome in emergency departments (EDs). We investigated whether mEWS can predict death, hospital admission, intensive care unit (ICU) admission, and in-hospital deaths in a Turkish setting.

Methods: We conducted an ED-based prospective study of 309 patients who presented to an academic medical center. The mEWS was recorded in all patients on ED admission. A mEWS >4 was used to define patients at high-risk for the study outcomes.

Results: Patients categorized as being at high-risk either were admitted to ICU (n=23) or to hospital (n=37) 56.6% of the time, or died in ED (n=16) or in hospital (n=29) 42.4% of the time. Patients categorized as being at low-risk either were admitted to ICU (n=25) or to hospital (n=52) 37.4% of the time, or died in ED (n=1) or in hospital (n=4) 2.5% of the time. In multivariate regression analysis, patients with a mEWS of 5 or more were 1.95 times more likely to be admitted to ICU than those with a score less than 5. Patients with high-risk mEWS were 35 times more likely to die in ED and 14 times more likely to die in hospital than those presenting with a low-risk score.

Conclusion: We conclude that scores on the mEWS predict ICU admission as well as ICU and in-hospital deaths.