GIÁ TRỊ CỦA THANG ĐIỂM CẢNH BÁO SỚM SỬA ĐỔI (MEWS) TRONG PHÂN TẦNG MỨC ĐỘ NẶNG VÀ TIÊN LƯỢNG NGUY CƠ TỬ VONG Ở BỆNH NHÂN CẤP CỨU NHẬP VIỆN TẠI TRUNG TÂM CẤP CỨU A9 - BỆNH VIỆN BẠCH MAI

Abstract

Background: The Modified Early Warning Score (MEWS) is a simple tool based on vital signs; however, its value in risk stratification and prognosis for patients in Vietnamese emergency departments remains understudied. This study was conducted to evaluate the role of the MEWS score at a tertiary emergency center. Objective: To determine the value of the MEWS score for severity stratification and mortality prognosis in patients admitted to the A9 Emergency Center, Bach Mai Hospital. Methods: A prospective, descriptive study was conducted on patients admitted in February 2025 to the A9 Emergency Center, Bach Mai Hospital. Patients aged ≥16 years who were confirmed to have an emergency condition and received initial treatment at the center were included. The MEWS score at the time of admission was calculated and its association with adverse clinical outcomes—including admission to the intensive care unit (ICU), organ dysfunction, and in-hospital mortality—was analyzed. Results: Among 963 eligible patients, there were 59 deaths (6.1%). Patient MEWS scores ranged from 1 to 10. Analysis by risk group showed: MEWS ≤ 2 group (n=731, 75.9%): The mortality rate was 2.05%, ICU admission rate was 4.9%, and severe deterioration rate was 4.1%. MEWS 3–4 group (n=154, 16.0%): The mortality rate was 6.5%, ICU admission rate was 15.6%, and severe deterioration rate was 14.9%. MEWS ≥ 5 group (n=78, 8.1%): The mortality rate was 43.6%, ICU admission rate was 41.0%, and severe deterioration rate was 66.7%.  Receiver Operating Characteristic (ROC) curve analysis showed the Area Under the Curve (AUC) for MEWS in predicting mortality was 0.835, which was comparable to the APACHE II score (AUC = 0.745). Conclusion: The MEWS score is a highly valuable tool for risk stratification and mortality prognosis for patients in the emergency department. The score has a strong positive correlation with the incidence of adverse events, with a threshold of ≥ 4 serving as a critical indicator of a life-threatening condition. Compared to the more complex APACHE II score, MEWS demonstrates comparable prognostic ability but is superior in its simplicity and rapid applicability, affirming its role as an effective screening tool in emergency practice