Effect of modifiye early warning score on the prognosis in malignant patients who admitted to emergency department

Recently, there has been a growing interest in the scoring systems used in the early detection of critical patients and the evaluation of prognosis and severity of the disease in the patients admitted to emergency services and intensive care units. Modified Early Warning Score (MEWS) is a method that has been proven as a valid bedside scoring system for the clinical evaluation of the patients presenting to emergency service. MEWS has been shown to provide predictive values for mortality, length of intensive care unit stay, risk of cardiac arrest, survival, and hospital discharge. In the present study, we aimed to investigate the risk of morbidity and mortality in patients with oncological and hematological malignancies by using MEWS scores and to evaluate the effectivity of MEWS in determining the severity of the diseases in patients presenting to emergency service and in predicting the outcomes of the hospitalized patients. The retrospective study reviewed 380 patients with oncological and hematological malignancies who presented to Dicle University Medical Hospital Emergency Service between January 1 and December 12, 2014. Of these, 189 patients were enrolled in the study. Age, gender, type of cancer, complaints at presentation, chemical therapies received, and the vital findings at presentation (body temperature, pulse rate, blood pressure, respiratory rate, oxygen saturation [SO2], and AVPU level) were recorded for each patient. The patients were divided into two groups depending on their MEWS score; Group I, MEWS<5 and Group II, MEWS≥5. The two groups were compared in terms of length of intensive care unit stay and mortality. The 189 patients included 117 (62%) men and 72 (38%) women. Of the male patients, 69 (59%) had MEWS<5 and 48 (41%) had MEWS≥5. Of the female patients, 50 (69.5%) had MEWS<5 and 22 (30.5%) had MEWS≥5. The rate of MEWS≥5 in patients hospitalized in the intensive care unit was significantly higher (p<0.001). Moreover, the rates of hospitalization and discharge after hospitalization were significantly higher in patients with MEWS<5, whereas the rates of intensive care unit stay and mortality after intensive care unit stay were significantly higher in patients with MEWS≥5. The results indicated that MEWS failed to predict the critical condition of the patients with malignancies since 33 of the patients with MEWS<5 were hospitalized at the intensive care unit and 22 of them died. However, it was revealed that MEWS can be used as a time- saving and practical scoring system in the triage at emergency service and in clinical/intensive care unit hospitalization. Nevertheless, MEWS alone may not be sufficient in the evaluation of the patients with diminished physiological reserve and rapid clinical deterioration and thus should be supported by various laboratory parameters such as lactate elevation and total protein and albumin concentration.