Prognostic significance of emergency department modified early warning score trend in critical ill elderly patients

Chih-Chun Kao; Yen-Chia Chen; Hsien-Hao Huang; The-Fu Hsu; David Hung-Tsang Yen; Ju-Sing Fan

doi:10.1016/j.ajem.2021.01.047

Prognostic significance of emergency department modified early warning score trend in critical ill elderly patients

Am J Emerg Med. 2021 Jun:44:14-19. doi: 10.1016/j.ajem.2021.01.047. Epub 2021 Jan 23.

Authors

Chih-Chun Kao¹, Yen-Chia Chen¹, Hsien-Hao Huang¹, The-Fu Hsu¹, David Hung-Tsang Yen¹, Ju-Sing Fan²

Affiliations

¹ Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
² Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC. Electronic address: jsfan@vghtpe.gov.tw.

PMID: 33571750
DOI: 10.1016/j.ajem.2021.01.047

Abstract

Objective: To explore the relationship between trends in emergency department modified early warning score (EDMEWS) and the prognosis of elderly patients admitted to the intensive care unit (ICU).

Methods: Consecutive non-traumatic elderly ED patients (≥65 years old) admitted to the ICU between July 2018 and June 2019 were enrolled in this retrospective cohort study. The selected patients had at least 2 separate MEWS during their ED stay. Detailed patient information was retrieved initially from the ICU database of our hospital and then crosschecked with electronic medical recording system to confirm the completeness and correctness of the data. Patients who had do-not-resuscitate order and those with incomplete data of EDMEWS, acute physiology and chronic health evaluation (APACHE) II score, or survival information (7-day and 30-day mortality) were excluded. The trends in EDMEWS were determined using the regression line of multiple MEWS measured during ED stay, in which EDMEWS trend progression was defined as the slope of the regression line > zero. The relationship between EDMEWS trend and prognosis was assessed using univariate and multivariate analyses (multiple logistic regression analysis).

Results: Of the 1423 selected patients, 499 (35.1%) had worsening 24-h APACHE II score, 110 (7.7%) died within 7 days, and 233 (16.4%) died within 30 days. Factors that were significantly associated with worsening 24-h APACHE II score, 7-day mortality, and 30-day mortality in univariate analysis were selected for inclusion into multiple logistic regression analyses. After adjusting for other covariates, EDMEWS trend progression was significantly associated with 24-h APACHE II score progression, 7-day mortality, and 30-day mortality.

Conclusions: EDMEWS trend progression was significantly associated with 24-h APACHE II score progression, 7-day mortality, and 30-day mortality in elderly ED patients admitted to the ICU. EDMEWS is a simple and useful tool for precisely monitoring patients' ongoing condition and predicting prognosis.

Keywords: Emergency Department Prognosis.; Emergency department; Intensive Care Unit; Intensive care unit; Modified Early Warning Score; Modified early warning score; Prognosis.

MeSH terms

APACHE
Aged
Aged, 80 and over
Critical Illness / mortality*
Early Warning Score*
Emergency Service, Hospital / organization & administration*
Female
Humans
Intensive Care Units
Male
Prognosis
Retrospective Studies
Taiwan / epidemiology