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      Calc Function

    • Calcs that help predict probability of a diseaseDiagnosis
    • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
    • Disease is diagnosed: prognosticate to guide treatmentPrognosis
    • Numerical inputs and outputsFormula
    • Med treatment and moreTreatment
    • Suggested protocolsAlgorithm

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    Patent Pending

    Modified Early Warning Score (MEWS) for Clinical Deterioration

    Determines the degree of illness of a patient.

    IMPORTANT

    We launched a COVID-19 Resource Center, including a critical review of recommended calcs. 

    INSTRUCTIONS

    Different institutions and regions may use different modifications of the MEWS. Verify that your institution uses the same points assignments listed here.

    When to Use
    Pearls/Pitfalls
    Why 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.

    • 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 judgement 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.
    • 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.
    ≤70 mmHg
    +3
    71-80 mmHg
    +2
    81-100 mmHg
    +1
    101-199 mmHg
    0
    ≥200 mmHg
    +2
    <40 bpm
    +2
    41-50 bpm
    +1
    51-100 bpm
    0
    101-110 bpm
    +1
    111-129 bpm
    +2
    ≥130 bpm
    +3
    <9 bpm
    +2
    9-14 bpm
    0
    15-20 bpm
    +1
    21-29 bpm
    +2
    ≥30 bpm
    +3
    <35°C / 95°F
    +2
    35–38.4°C / 95–101.1°F
    0
    ≥38.5°C / 101.3°F
    +2
    Alert
    0
    Reacts to voice
    +1
    Reacts to pain
    +2
    Unresponsive
    +3
    Confirmed positive
    Suspected
    Unlikely
    Confirmed negative

    Result:

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    Next Steps
    Evidence
    Creator Insights
    Dr. Christian Peter Subbe

    About the Creator

    Christian Peter Subbe, MD, MRCP (London), is a practicing clinician in Respiratory, General Internal & Intensive Care Medicine. He is a senior clinical lecturer at Bangor University and a consultant at the Ysbyty Gwynedd, Bangor. Dr. Subbe's current research interests include recognition of acute illness, the interface of acute and critical care medicine, rapid response systems and smoking cessation in hospitalized patients.

    To view Dr. Christian Peter Subbe's publications, visit PubMed

    Content Contributors
    About the Creator
    Dr. Christian Peter Subbe
    Content Contributors