Evaluating the Use of a Modified Early Warning Score in Predicting Serious Adverse Events in Iranian Hospitalized Patients: A Prognostic Study

Abstract

Introduction: Assessment of early clinical warning signs and appropriate response can prevent serious adverse events in hospitalized patients. The Modified Early Warning Score (MEWS) is an applicable early warning sign system that can be used to predict serious adverse events. This study aimed to evaluate the predictive capacity of the MEWS to identify patients in an Iranian hospital who are at risk of developing serious adverse events.

Methods: In this prognostic study, 381 adult patients from the emergency department who were admitted to an inpatient hospital unit of an Iranian hospital from May 2018 to October 2018 were included. The MEWS tool was completed for each patient at the time of admission and then daily for a period of up to 30 continuous days after admission or until the development of a serious adverse event. Receiver operating characteristic, specificity, sensitivity, positive predictive values, and negative predictive values were calculated.

Results: In this study, a MEWS of ≥3 on admission was associated with an increased likelihood of developing serious adverse events within 30 days of admission with the area under the curve of 0.82 (95% confidence interval [CI]: 0.77-0.85), sensitivity of 82.81% (95% CI: 71.3-91.1), specificity of 75.39% (95% CI: 70.3-80), positive predictive value of 40.5% (95% CI: 35.2-45.9), and negative predictive value of 95.6% (95% CI: 92.7-97.4).

Discussion: A MEWS ≥3 on admission can predict the occurrence of serious averse events in patients admitted to an Iranian hospital for 30 continuous days.

Keywords: Modified Early Warning Score; Predictive value of tests; Sensitivity and specificity; Serious adverse events.