Objective:To explore the application and effectiveness of the Modified Early Warning Score(MEWS)in emergency triage and evaluate its impact on triage efficiency and accuracy.Methods:A total of 6,000 patients who visit...Objective:To explore the application and effectiveness of the Modified Early Warning Score(MEWS)in emergency triage and evaluate its impact on triage efficiency and accuracy.Methods:A total of 6,000 patients who visited the emergency department between February 2023 and July 2024 were selected and randomly divided into the observation group and the control group,with 3,000 patients in each group.The observation group used MEWS for triage,while the control group adopted the traditional experience-based triage method.The triage time and accuracy were recorded and compared between the two groups.Results:The triage time of the observation group was significantly shorter than that of the control group(0.84±0.21 min vs.1.42±0.35 min,t=6.54,P<0.01).The triage accuracy of the observation group was 98.67%(2,960/3,000),significantly higher than the control group’s 93.33%(2,800/3,000,χ²=5.95,P<0.05).Conclusion:MEWS significantly improves triage efficiency and accuracy in emergency triage,providing an effective tool for optimizing emergency resource allocation,reducing patient wait times,and ensuring patient safety.It has high clinical application value.Further research is needed to validate its effectiveness in multi-center and large-sample studies and to explore its integration with intelligent technologies.展开更多
BACKGROUND:This study was undertaken to validate the use of the modified early warning score(MEWS) as a predictor of patient mortality and intensive care unit(ICU)/ high dependency(HD)admission in an Asian population....BACKGROUND:This study was undertaken to validate the use of the modified early warning score(MEWS) as a predictor of patient mortality and intensive care unit(ICU)/ high dependency(HD)admission in an Asian population.METHODS:The MEWS was applied to a retrospective cohort of 1 024 critically ill patients presenting to a large Asian tertiary emergency department(ED) between November 2006 and December2007.Individual MEWS was calculated based on vital signs parameters on arrival at ED.Outcomes of mortality and ICU/HD admission were obtained from hospital records.The ability of the composite MEWS and its individual components to predict mortality within 30 days from ED visit was assessed.Sensitivity,specificity,positive and negative predictive values were derived and compared with values from other cohorts.A MEWS of ≥4 was chosen as the cut-off value for poor prognosis based on previous studies.RESULTS:A total of 311(30.4%) critically ill patients were presented with a MEWS ≥4.Their mean age was 61.4 years(SD 18.1) with a male to female ratio of 1.10.Of the 311 patients,53(17%)died within 30 days,64(20.6%) were admitted to ICU and 86(27.7%) were admitted to HD.The area under the receiver operating characteristic curve was 0.71 with a sensitivity of 53.0%and a specificity of 72.1%in addition to a positive predictive value(PPV) of 17.0%and a negative predictive value(NPV)of 93.4%(MEWS cut-off of ≥4) for predicting mortality.CONCLUSION:The composite MEWS did not perform well in predicting poor patient outcomes for critically ill patients presenting to an ED.展开更多
Objective:To evaluate the predictive value of Modified Early Warning Score(MEWS)for neurological disease prognosis and identify prognostic factors.Methods:This retrospective study analyzed 768 neurological patients wi...Objective:To evaluate the predictive value of Modified Early Warning Score(MEWS)for neurological disease prognosis and identify prognostic factors.Methods:This retrospective study analyzed 768 neurological patients with MEWS≥4(June 2022–June 2024).Patients were stratified by outcomes(favorable/unfavorable).Multivariable logistic regression and ROC analysis were performed.Results:108 cases(13.1%)had unfavorable outcomes.Significant prognostic factors included:age,TBI history,onset-to-admission time,PT,MEWS score,and MEWS≥4 frequency(all P<0.05).MEWS showed AUC=0.749(sensitivity 62.0%,specificity 77.4%).Conclusion:MEWS demonstrates moderate predictive value(AUC=0.749)for neurological outcomes.Consciousness assessment limitations(56.5%impaired cases)may affect sensitivity.A specialized model incorporating pupillary reflexes and GCS is recommended for improved early warning.展开更多
Emphysematous pyelonephritis(EPN)is a severe,a lethal necrotizing upper urinary tract infection,characterized by gas production within the renal pa-renchyma,collecting system,or perinephric tissue.EPN is emerging as a...Emphysematous pyelonephritis(EPN)is a severe,a lethal necrotizing upper urinary tract infection,characterized by gas production within the renal pa-renchyma,collecting system,or perinephric tissue.EPN is emerging as a sig-nificant concern,necessitating early diagnosis,severity assessment,and timely intervention to improve outcomes.This study proposes a modified National Early Warning Score 2(mNEWS 2)to enhance risk stratification and predictive accuracy in EPN management.The mNEWS 2 refines the original NEWS 2 system,which aggregates 6 physiological indicators(body temperature,systolic blood pressure,pulse rate,oxygen saturation,breathing rate,and degree of consciousness),by incorporating weighted risk stratification indices and specific cutoff values derived from clinical observations,statistical modeling,and predictive per-formance analysis.A pilot study identified optimal thresholds,with a score of 15 maximizing predictive performance for mortality risk and intervention needs,validated through receiver operating characteristic curve analysis.So,the mNEWS 2 score represents a significant advancement in EPN management,offering improved risk stratification and treatment outcomes.展开更多
目的探讨改良早期预警评分(modified early warning score,MEWS)在早期识别潜在危重症患者中的应用价值。方法选取我院急诊科2017年1月-2019年1月收治的200例患者为研究对象,按照就诊顺序均分为研究组(对照组基础上采用改良早期预警评...目的探讨改良早期预警评分(modified early warning score,MEWS)在早期识别潜在危重症患者中的应用价值。方法选取我院急诊科2017年1月-2019年1月收治的200例患者为研究对象,按照就诊顺序均分为研究组(对照组基础上采用改良早期预警评分系统)和对照组(采用常规急诊分诊流程),然后根据评分结果分流至红、黄、绿区域,比较分两组患者分诊情况、去向以及转归情况。结果研究组绿区分组占比高于对照组(P<0.05);MEWS分数越高,患者病情越重,病死率越高。结论MEWS评分系统将急诊患者病情分值化,为护理提供有效的参考数据,可准确鉴别潜在危重患者,值得临床应用。展开更多
目的探讨（modified early warning system，MEWS）评分在急诊批量伤员救治中的实践意义。方法将2011年6月-2016年10月新疆军区总医院急诊科救治的459例批量伤员使用MEWS评分与AIS—ISS评分进行一致性分析，并与现存的各评分比较推测近...目的探讨（modified early warning system，MEWS）评分在急诊批量伤员救治中的实践意义。方法将2011年6月-2016年10月新疆军区总医院急诊科救治的459例批量伤员使用MEWS评分与AIS—ISS评分进行一致性分析，并与现存的各评分比较推测近、远期死亡率。结果根据Kappa一致性分析，本研究Kappa值为0．691，P=0．000〈0．005有统计学意义，提示一致性好。通过c—statistics显示推测MEWS远期死亡率为0．945（95％CI 0．879-0．961），短期死亡率为0．962（95％CI 0．901-0．973）。结论在院内急救批量伤员拣伤分类中，MEWS评分与AIS—ISS评分一致性好，MEWS评分推测死亡率与现存的各评分相近或更优，可以应用于急诊科的批量伤员检伤分类。展开更多
目的探讨改良早期预警评分(Modified Early Warningscore,MEWS)识别危重症患者的临床应用价值。方法收集360例死亡患者的相关临床资料-包括性别、年龄、生命体征、呼吸支持、氧饱和度、意识、尿量、化验、诊断等。不同参数组合产生4种M...目的探讨改良早期预警评分(Modified Early Warningscore,MEWS)识别危重症患者的临床应用价值。方法收集360例死亡患者的相关临床资料-包括性别、年龄、生命体征、呼吸支持、氧饱和度、意识、尿量、化验、诊断等。不同参数组合产生4种MEWS评分,即MEWSa、MEWSb、MEWSc、MEWSd。分别对360例病人同时进行MEWS评分和APACHEⅡ评分。统计方法采用相关性分析、ROC曲线及多个独立样本非参数检验,以探讨4种MEWS评分方法和APACHEⅡ评分的相关性,4种MEWS评分之间的差异。结果4种MEWS评分与APACHEⅡ评分均显示较好的相关性,(P均<0.001)。区分危重症患者的拟定最佳界点均为3分。其中MEWSa、MEWSc、MEWSd在内外科患者之间无统计学差异(P均>0.05)。结论MEWS评分可以替代APACHEⅡ评分应用于临床,以识别危重症患者。其中MEWSc评分可能是广泛适用于内外科患者较好的评分,判别危重症的阈值≥3分,特异度为85.5%,灵敏度为74.3%,参数组成包括收缩压、心率、呼吸频率、意识水平、体温、呼吸支持6个参数。展开更多
目的 探讨英国国家早期预警评分（national early warning score, NEWS）、改良早期预警评分（modified early warning score，MEWS）和急诊脓毒症死亡风险评分（mortality in emergency department sepsis score，MEDS）对急诊感染患...目的 探讨英国国家早期预警评分（national early warning score, NEWS）、改良早期预警评分（modified early warning score，MEWS）和急诊脓毒症死亡风险评分（mortality in emergency department sepsis score，MEDS）对急诊感染患者预后的评估价值，并探究新的评分方法。 方法 回顾性分析2016-01～2016-08就诊于清华大学附属北京清华长庚医院急诊科的215例感染患者，记录性别、年龄、既往基础疾病、就诊时生命体征、感染部位及相关实验室检验，分别进行NEWS、MEWS和MEDS，以进入研究后28 d生存情况分为死亡组与存活组，分析两组间各评分差异。为探究新的评分方法，进一步应用Logistic回归分析评估各因素与28 d预后的关系，并最终获得拟合方程。应用受试者工作特征曲线（ROC曲线）比较各评分系统及拟合方程对28 d预后的预测能力。结果 215例急性感染患者28 d 病死率为14.88%。死亡组NEWS、MEWS和MEDS均高于存活组。单因素Logistic回归分析显示，年龄、恶性肿瘤病史、心率、呼吸频率、收缩压、血氧饱和度（SpO2）、血小板、红细胞压积、血肌酐（serum creatinine, Scr）、肾小球滤过率（estimated glomerular filtration rate, eGFR）是28 d死亡的预测因素（P＜0.05）。NEWS、MEWS、MEDS和联合多变量建立的拟合方程对28 d死亡预测的ROC曲线下面积分别为0.881、0.757、0.935和0.954。NEWS与MEDS比较差异无统计学意义（P＞0.05），与MEWS比较差异有统计学意义（P＜0.01）。联合多变量后建立的拟合方程敏感度最佳，曲线下面积最大，优于MEWS（P＜0.01）及NEWS（P＜0.05）。结论 MEDS的预测能力同NEWS能力相当，优于MEWS。联合MEDS与心率、Scr获得的拟合方程的预测能力更优于NEWS和MEWS。展开更多
目的比较序贯器官衰竭评分(sepsis-related organ failure assessment,SOFA)、快速序贯器官衰竭评分(quick sepsis-related organ failure assessment,qSOFA)、改良早期预警评分(modified earl ywarning score,MEWS)和全身炎症反应综合...目的比较序贯器官衰竭评分(sepsis-related organ failure assessment,SOFA)、快速序贯器官衰竭评分(quick sepsis-related organ failure assessment,qSOFA)、改良早期预警评分(modified earl ywarning score,MEWS)和全身炎症反应综合征评分(systemic inflammatory response syndrome,SIRS)对急诊监护室(emergent intensive care unit,EICU)疑似感染患者28 d死亡的预测价值.方法前瞻性队列研究法对在2017年2月至2018年3月期间我院EICU疑似感染患者进行观察.记录临床资料和上述四种评分,随访入EICU 28 d的全因死亡.结果纳入研究的163例疑似感染患者,28d随访中死亡51例(31%).四种评分的曲线下面积(area under curve,AUC)分别为0.782(95% CI 0.711~0.843)、0.704(95% CI 0.628~0.773)、0.640(95% CI 0.562~0.714)和0.516(95% CI 0.436~0.595).结论SOFA评分对EICU疑似感染患者28 d死亡的预测能力最好.展开更多
文摘Objective:To explore the application and effectiveness of the Modified Early Warning Score(MEWS)in emergency triage and evaluate its impact on triage efficiency and accuracy.Methods:A total of 6,000 patients who visited the emergency department between February 2023 and July 2024 were selected and randomly divided into the observation group and the control group,with 3,000 patients in each group.The observation group used MEWS for triage,while the control group adopted the traditional experience-based triage method.The triage time and accuracy were recorded and compared between the two groups.Results:The triage time of the observation group was significantly shorter than that of the control group(0.84±0.21 min vs.1.42±0.35 min,t=6.54,P<0.01).The triage accuracy of the observation group was 98.67%(2,960/3,000),significantly higher than the control group’s 93.33%(2,800/3,000,χ²=5.95,P<0.05).Conclusion:MEWS significantly improves triage efficiency and accuracy in emergency triage,providing an effective tool for optimizing emergency resource allocation,reducing patient wait times,and ensuring patient safety.It has high clinical application value.Further research is needed to validate its effectiveness in multi-center and large-sample studies and to explore its integration with intelligent technologies.
基金supported by grants from SingHealth Talent Development Fund,Singapore(TDF/CS001/2006)InfoComm Research Cluster,Nanyang Technological University,Singapore(2006ICT09)
文摘BACKGROUND:This study was undertaken to validate the use of the modified early warning score(MEWS) as a predictor of patient mortality and intensive care unit(ICU)/ high dependency(HD)admission in an Asian population.METHODS:The MEWS was applied to a retrospective cohort of 1 024 critically ill patients presenting to a large Asian tertiary emergency department(ED) between November 2006 and December2007.Individual MEWS was calculated based on vital signs parameters on arrival at ED.Outcomes of mortality and ICU/HD admission were obtained from hospital records.The ability of the composite MEWS and its individual components to predict mortality within 30 days from ED visit was assessed.Sensitivity,specificity,positive and negative predictive values were derived and compared with values from other cohorts.A MEWS of ≥4 was chosen as the cut-off value for poor prognosis based on previous studies.RESULTS:A total of 311(30.4%) critically ill patients were presented with a MEWS ≥4.Their mean age was 61.4 years(SD 18.1) with a male to female ratio of 1.10.Of the 311 patients,53(17%)died within 30 days,64(20.6%) were admitted to ICU and 86(27.7%) were admitted to HD.The area under the receiver operating characteristic curve was 0.71 with a sensitivity of 53.0%and a specificity of 72.1%in addition to a positive predictive value(PPV) of 17.0%and a negative predictive value(NPV)of 93.4%(MEWS cut-off of ≥4) for predicting mortality.CONCLUSION:The composite MEWS did not perform well in predicting poor patient outcomes for critically ill patients presenting to an ED.
基金Research on the Measurement of Pulmonary Compliance and Its Guided Therapeutic Efficacy Analysis in Patients with ARDS Secondary to Severe Multiple Injuries(Project No.:XSD2023002)。
文摘Objective:To evaluate the predictive value of Modified Early Warning Score(MEWS)for neurological disease prognosis and identify prognostic factors.Methods:This retrospective study analyzed 768 neurological patients with MEWS≥4(June 2022–June 2024).Patients were stratified by outcomes(favorable/unfavorable).Multivariable logistic regression and ROC analysis were performed.Results:108 cases(13.1%)had unfavorable outcomes.Significant prognostic factors included:age,TBI history,onset-to-admission time,PT,MEWS score,and MEWS≥4 frequency(all P<0.05).MEWS showed AUC=0.749(sensitivity 62.0%,specificity 77.4%).Conclusion:MEWS demonstrates moderate predictive value(AUC=0.749)for neurological outcomes.Consciousness assessment limitations(56.5%impaired cases)may affect sensitivity.A specialized model incorporating pupillary reflexes and GCS is recommended for improved early warning.
文摘Emphysematous pyelonephritis(EPN)is a severe,a lethal necrotizing upper urinary tract infection,characterized by gas production within the renal pa-renchyma,collecting system,or perinephric tissue.EPN is emerging as a sig-nificant concern,necessitating early diagnosis,severity assessment,and timely intervention to improve outcomes.This study proposes a modified National Early Warning Score 2(mNEWS 2)to enhance risk stratification and predictive accuracy in EPN management.The mNEWS 2 refines the original NEWS 2 system,which aggregates 6 physiological indicators(body temperature,systolic blood pressure,pulse rate,oxygen saturation,breathing rate,and degree of consciousness),by incorporating weighted risk stratification indices and specific cutoff values derived from clinical observations,statistical modeling,and predictive per-formance analysis.A pilot study identified optimal thresholds,with a score of 15 maximizing predictive performance for mortality risk and intervention needs,validated through receiver operating characteristic curve analysis.So,the mNEWS 2 score represents a significant advancement in EPN management,offering improved risk stratification and treatment outcomes.
文摘目的探讨改良早期预警评分(modified early warning score,MEWS)在早期识别潜在危重症患者中的应用价值。方法选取我院急诊科2017年1月-2019年1月收治的200例患者为研究对象,按照就诊顺序均分为研究组(对照组基础上采用改良早期预警评分系统)和对照组(采用常规急诊分诊流程),然后根据评分结果分流至红、黄、绿区域,比较分两组患者分诊情况、去向以及转归情况。结果研究组绿区分组占比高于对照组(P<0.05);MEWS分数越高,患者病情越重,病死率越高。结论MEWS评分系统将急诊患者病情分值化,为护理提供有效的参考数据,可准确鉴别潜在危重患者,值得临床应用。
文摘目的探讨改良早期预警评分(Modified Early Warningscore,MEWS)识别危重症患者的临床应用价值。方法收集360例死亡患者的相关临床资料-包括性别、年龄、生命体征、呼吸支持、氧饱和度、意识、尿量、化验、诊断等。不同参数组合产生4种MEWS评分,即MEWSa、MEWSb、MEWSc、MEWSd。分别对360例病人同时进行MEWS评分和APACHEⅡ评分。统计方法采用相关性分析、ROC曲线及多个独立样本非参数检验,以探讨4种MEWS评分方法和APACHEⅡ评分的相关性,4种MEWS评分之间的差异。结果4种MEWS评分与APACHEⅡ评分均显示较好的相关性,(P均<0.001)。区分危重症患者的拟定最佳界点均为3分。其中MEWSa、MEWSc、MEWSd在内外科患者之间无统计学差异(P均>0.05)。结论MEWS评分可以替代APACHEⅡ评分应用于临床,以识别危重症患者。其中MEWSc评分可能是广泛适用于内外科患者较好的评分,判别危重症的阈值≥3分,特异度为85.5%,灵敏度为74.3%,参数组成包括收缩压、心率、呼吸频率、意识水平、体温、呼吸支持6个参数。
文摘目的比较序贯器官衰竭评分(sepsis-related organ failure assessment,SOFA)、快速序贯器官衰竭评分(quick sepsis-related organ failure assessment,qSOFA)、改良早期预警评分(modified earl ywarning score,MEWS)和全身炎症反应综合征评分(systemic inflammatory response syndrome,SIRS)对急诊监护室(emergent intensive care unit,EICU)疑似感染患者28 d死亡的预测价值.方法前瞻性队列研究法对在2017年2月至2018年3月期间我院EICU疑似感染患者进行观察.记录临床资料和上述四种评分,随访入EICU 28 d的全因死亡.结果纳入研究的163例疑似感染患者,28d随访中死亡51例(31%).四种评分的曲线下面积(area under curve,AUC)分别为0.782(95% CI 0.711~0.843)、0.704(95% CI 0.628~0.773)、0.640(95% CI 0.562~0.714)和0.516(95% CI 0.436~0.595).结论SOFA评分对EICU疑似感染患者28 d死亡的预测能力最好.
