Modified Early Warning Score (MEWS) Calculator

How does this Modified Early Warning Score (MEWS) calculator work?

This is a health tool that evaluates the degree of illness in a patient and the likelihood of transfer to intensive care according to standard physiological parameters that can easily be monitored at the bedside. It is based on the modified version of the early warning signs score and also provides instructions on the following care steps, based on the overall score obtained by the patient.

This Modified early warning score (MEWS) calculator uses the following criteria analyzed:

■ Systolic blood pressure – offering information about the circulatory system and blood flow in general, with values ranging from below 70 mmHg to over 200 mmHg.

■ Heart rate – offering information on the work of the heart as a pump and the integrity of coronary veins, with values between under 40 beats per minute to over 130 bpm.

■ Respiratory rate – informing about the work of the lungs in inhalation and expiration, with values between under 9 breaths per minute to over 30 breaths per minute.

■ Body temperature – with values under 35°C to over 38.5°C, also provided in Fahrenheit.

■ AVPU score – assessment of level of consciousness, with results from alert, responsive to voice, to pain or unresponsive.

Often the MEWS scoring system is used to screen for patients with declining conditions who might need transfer to a higher degree of care and often comes before clinical judgment due to the high specificity it carries. It can be used by any medical specialist with very little training in regard to the interpretation and can be frequently used not just in admissions such as the Glasgow coma scale.

The original model focused on the principle that clinical deterioration can be quantified through physiological parameter changes and each of these changes was given a weigh in the EWS system.

There is also available the National Early Warning Score (NEWS) model, developed by the Royal College of Physicians in the UK in order to screen for different patient care levels and likelihood of transfer to ICU. The early warning score (EWS) was initially described in the Morgan study in 1997.

MEWS interpretation

Each of the answers provided to the five criteria in the modified early warning score, weighs a number of points, from 0 to 3. Once all the answers have been chosen, the calculator will sum them to provide the final result, which will be the MEWS score. Below you can find the meaning for each scoring group:

■ 0 – 1: This is a low score; it suggests the need for a new control is in the following 12 to 24 hours and that the patient can still be monitored by a registered nurse.

■ 2 – 4: This is a medium score; it suggests that the patient should still remain under the care of a specialized nurse and the ward medical professional and that the next control should be in the following 2 to 8 hours, depending on the patient’s status.

■ 5 and above: This is a high score; it suggests an increased likelihood for the patient to be moved in a critical care unit in order to benefit from specialized care according to the medical needs.

References

1) Morgan RJM, Williams F, Wright MM. An early warning scoring system for detecting developing critical illness. Clin Intensive Care 1997; 8: 100.

2) Subbe CP, Kruger M, Rutherford P, Gemmel L. (2001) Validation of a modified Early Warning Score in medical admissions. QJM; 94(10):521-6.

3) Suppiah A, Malde D, Arab T, Hamed M, Allgar V, Morris-Stiff G, Smith A. (2014) The Modified Early Warning Score (MEWS): an instant physiological prognostic indicator of poor outcome in acute pancreatitis. JOP; 15(6):569-76.

4) Alam N, Hobbelink EL, van Tienhoven AJ, van de Ven PM, Jansma EP, Nanayakkara PW. (2014) The impact of the use of the Early Warning Score (EWS) on patient outcomes: a systematic review. Resuscitation; 85(5):587-94