Effectiveness of Modified Early Warning Score (MEWS) in the Outcome of In-Hospital Adult Cardiac Arrests in a Tertiary Hospital

  • Johnson S
  • Nileswar A
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Abstract

Introduction: Cardiac arrest in a hospital often follows a period of severe illness and if the pre-arrest scenario is recognised early, cardiac arrest may be averted or identified in time. This should be reflected by an improvement in the outcome. The modified early warning score (MEWS) is a useful tool for identifying hospitalised patients in need of a higher level of care and those at risk of in-hospital death. Use of the MEWS as a triage tool to identify patients needing hospital admission and those at increased risk of in-hospital death has been evaluated only to a limited extent. This study was aimed at evaluating the effectiveness of Modified Early Warning Score (MEWS) in the outcome of Inhospital adult cardiac arrest in a tertiary hospital. Methods: This was a prospective study conducted in patients who sustained cardiac arrest in a tertiary hospital from September 2009 to May 2013. We included adult patients (Age >18 years) who had in-hospital cardiac arrest. We excluded cardiac arrests in operation theatre and patients brought dead to the hospital. Tools used to collect data were Modified Utstein style Format for standard reporting of In-hospital cardiopulmonary resuscitation and Modified early warning score chart. The initial phase was the pre MEWS data collection and second phase was the post MEWS data collection. Awareness to fill the MEWS chart was given to all the staff nurses and doctors in the hospital prior to the introduction of the MEWS chart. Results: There were 1135 patients in the Pre EWS period and 820 patients in the Post EWS period. The survival to hospital discharge was more (Pre EWS- 59, Post EWS- 138) after the introduction of MEWS and it was statistically significant (P = 0.001). There was a significant difference in the Return of Spontaneous circulation duration (ROSC) between Pre and Post MEWS (P = 0.001). There were significantly more patients in Cerebral performance category (CPC) 1-2 in the post MEWS compared to pre MEWS (CI 14.63- 31.03 and P = 0.0001). Discussion and Conclusion: In the present study the survival to hospital discharge improved significantly from 5% to 16.82 % pre and post MEWS and it is similar to the results of Nauman Naeem et al. where introduction of MEWS resulted in a better survival to hospital discharge and it was statistically significant - (5.2% Vs 16.8 %). In our study there was no significant difference in the CPC but there was a change in the ADL in the post MEWS period which shows that when the patients were resuscitated earlier, the outcome both in terms of survival and neurological status in the long term. This study suggest that MEWS could be widely used in the hospitals to detect the deterioration of in- patients by the ward nurse and the patients could be resuscitated effectively and quite earlier so that the neurological status is regained in a better manner. This is the first study that evaluated the effectiveness of MEWS in CPC and ADL. MEWS significantly improves the ROSC, survival to hospital discharge and Neurological outcome of the patient.

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Johnson, S., & Nileswar, A. (2015). Effectiveness of Modified Early Warning Score (MEWS) in the Outcome of In-Hospital Adult Cardiac Arrests in a Tertiary Hospital. Journal of Pulmonary & Respiratory Medicine, 05(04). https://doi.org/10.4172/2161-105x.1000285

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