Modified Early Warning Score (MEWS) for Clinical Deterioration
Why Use
Patients with low MEWS can continue receiving their usual care and observation. Patients with high MEWS should be watched more attentively and considered for transfer to a higher care unit such as an ICU.
When to Use
The MEWS can be used on all hospitalized patients to allow for the early detection of clinical deterioration and potential need for higher level of care.
Formula
Pearls / Pitfalls
The Modified Early Warning System (MEWS) is a tool designed to identify patients with declining conditions. It has been shown to be superior to clinical for this purpose. It was originally designed for nurses but can be used by any healthcare professional with adequate training. MEWS is based on the principle that clinical deterioration can be seen through subtle changes in a number of parameters as well as large changes within a single variable. The scale is calibrated to different populations and sometimes expanded to include additional parameters. While a score of 5 or more has been shown to be associated with a higher likelihood of admission to an intensive care unit or death, this threshold can be modified to accommodate different patient populations or clinical settings. The National Early Warning Score (NEWS) 2 was developed and updated by the Royal College of Physicians in the UK to standardize the identification and response to deteriorating patients.
Management
Once the MEWS identifies a patient at risk of deterioration, the medical team will need to identify the cause and address it accordingly.
Critical Actions
This score can be used by any healthcare worker with proper training in how to use it and interpret the results. It is meant to be used on a regular basis rather than once on admission.
More Information
See formula table; below: Criteria Point Value Systolic BP (mmHg) ≤70 +3 71-80 +2 81-100 +1 101-199 0 ≥200 +2 Heart rate (beats per minute) <40 +2 41-50 +1 51-100 0 101-110 +1 11-129 +2 >130 +3 Respiratory rate (breaths per minute) <9 +2 9-14 0 15-20 +1 21-29 +2 >30 +3 Temperature in °C (°F) <35 (<95) +2 35.0–38.4 (95–101.12) 0 >38.5 (101.3) +2 AVPU Alert? 0 Voice? +1 Pain? +2 Unresponsive? +3 Interpretation A score ≥5 is statistically linked to increased likelihood of death or admission to an intensive care unit. For any single physiological parameter scored +3, consider higher level of care for patient.