Modified Early Warning Score as a Predictor of Early Readmissions in an Intensive Care Unit: A Case-Control Study
DOI:
https://doi.org/10.24950/rspmi/O/93/19/3/2019Keywords:
Continuity of Patient Care, Hospital Mortality, Intensive Care Units, Patient ReadmissionAbstract
Introduction: Early readmission rate (≤ 2 after discharge) to
the Intensive Care Units (ICU) is used as a quality measure.
Since readmitted patients have poor outcomes, tools to
identify them before readmission happens are needed. The
Modified Early Warning Score (MEWS) identifies patients
at high risk of clinical deterioration, admission to ICU and
intra-hospital mortality when done at the Emergency Room
or at the ward. We tested MEWS as a predictor of early readmissions to the ICU when done at the moment of discharge
from these Units.
Material and Methods: We conducted a case-control study
(1:1) comparing patients with early readmissions with controls without readmissions to a polyvalent ICU, during a period of 9 years. Logistic regression was used to determine the
discriminative power of MEWS to predict early readmissions
to the ICU. The predictive precision of the score was calculated by the area under the receiver operating characteristic
curve.
Results: We paired 114 patients with early readmission (rate
of 1.5%) with 114 controls. Any value of MEWS > 0 was associated with a significant increase in the risk of early readmission. A value of MEWS = 0 showed a negative predictive
value of 99.7%. The area under the receiver operating characteristic curve of the MEWS to the prediction of early readmissions was 0.69 (IC95%: 0.62-0.76; p < 0.001).
Discussion: The predictive precision of MEWS to this purpose was higher than other scores reported in the literature.
Conclusion: MEWS is an easy clinical score with the potential
to increase patient safety at the moment of discharge from
the ICU.
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