Open Access, Peer-reviewed
eISSN 2093-758X
    J Korean Acad Nurs. 2014 Apr;44(2):219-227. Korean.
    Published online Apr 30, 2014.
    https://doi.org/10.4040/jkan.2014.44.2.219
    © 2014 Korean Society of Nursing Science
    Original Article

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

    Ju Ry Lee,1 and 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, Email: reniechoi@hanmail.net
    Received December 04, 2013; Revised December 16, 2013; Accepted March 31, 2014.

    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

    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%).

    Tables

    Table 1
    Modified Early Warning Score

    Table 2
    Baseline Characteristics of Sample

    Table 3
    Physiological Parameters and MEWS Dichotomized according to Point of Time

    Table 4
    Logistic Regression Analysis for ICU Transfer

    Notes

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

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    MeSH Terms
    APACHE
    Aged
    Blood Pressure/physiology
    Female
    Hospital Mortality
    Humans
    Intensive Care Units
    Lactic Acid/analysis
    Logistic Models
    Male
    Middle Aged
    Odds Ratio
    Patients' Rooms
    ROC Curve
    Reproducibility of Results
    Retrospective Studies
    Risk Assessment/methods
    Sepsis/pathology*
    Shock, Septic/pathology*
    Metrics
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