Modified Early Warning Score Changes Prior to Cardiac Arrest in General Wards

PURPOSE The frequency, extent, time frame, and implications of changes to the modified early warning score (MEWS) in the 24 hours prior to cardiac arrest are not known. Our aim was to determine the prevalence and trends of the MEWS prior to in-hospital cardiac arrest (IHCA) on a ward, and to evaluate the association between changes in the MEWS and in-hospital mortality. METHODS A total of 501 consecutive adult IHCA patients who were monitored and resuscitated by a medical emergency team on the ward were enrolled in the study between March 2009 and February 2013. The MEWS was calculated at 24 hours (MEWS24), 16 hours (MEWS16), and 8 hours (MEWS8) prior to cardiac arrest. RESULTS Out of 380 patients, 268 (70.5%) had a return of spontaneous circulation. The survival rate to hospital discharge was 25.8%. When the MEWS was divided into three risk groups (low: ≤2, intermediate: 3-4, high: ≥5), the distribution of the low-risk MEWS group decreased at each time point before cardiac arrest. However, even 8 hours prior to cardiac arrest, 45.3% of patients were still in the low MEWS group. The MEWS was associated with in-hospital mortality at each time point. However, increasing MEWS value from MEWS24 to MEWS8 was not associated with in-hospital mortality [OR 1.24 (0.77-1.97), p = 0.38]. CONCLUSIONS About half of patients were still in low MEWS group 8 hours prior to cardiac arrest and an increasing MEWS only occurred in 46.8% of patients, suggesting that monitoring the MEWS alone is not enough to predict cardiac arrest.