Efficacy Of Improved Mews Score Combined With Tissue Oxygen Saturation And Peripheral Oxygen Saturation Index In Emergency Predetection Triage

Objective : According to the modified early warning score(MEWS),which is commonly used in international emergency predetection triage,oxygen saturation index tissue oxygen saturation(St O2)and peripheral oxygen saturation(Sp O2)were added.Two new scoring methods were developed to evaluate the severity of patients’ disease: combined St O2 score(MEWS II score)and combined Sp O2 score(MEWS III score).To compare whether MEWS II score and MEWS III score were stronger than MEWS score in the assessment of patients’ condition in the triage of emergency precheck.Methods:A total of 1036 patients with complete data in the emergency department of the First Affiliated Hospital of China Medical University from July 2022 to October2022 were analyzed.During pre-examination triage,MEWS score,MEWS II score and MEWS III score were used to evaluate the critical severity of the patients who came to see us,and the time required for each score was recorded.APACHE II score was completed after the patient visited and completed the examination.The MEWS score and APACHE II score will be assigned according to the commonly used international indicators.In MEWS II score and MEWS III score,5 parameters including body temperature,heart rate,systolic blood pressure,respiratory rate and consciousness state were assigned according to MEWS score,while St O2 and Sp O2 were assigned according to NEWS score.In the MEWS II score,0 points were given for St O2 > 90%,2 points were given for 75%-90%,and 3 points were given for <75%.In the MEWS III score,Sp O2≥96% is assigned 0 points,94%-95% is assigned1 points,92-93% is assigned 2 points,and ≤91% is assigned 3 points.According to the standard grading method,the total score of MEWS was ≤4 for mild patients,5-8for moderate patients,and ≥9 for severe patients.MEWS II score and MEWS III score were based on the grading criteria of NEWS score.The total scores were ≤4for mild patients,5-6 for moderate patients,and ≥7 for severe patients.APACHE II score < 15 points is considered as mild patients,≥15 points is considered as severe patients,which is used as an objective evaluation index of the severity of patients’ critical illness.Admission to the general ward was considered as a good outcome,admission to ICU or death in hospital was considered as a bad outcome,which was used as an objective evaluation index of patient outcome.APACHE II score,department and survival of patients were counted after admission.The three scoring methods were compared with APACHE II scoring and patient outcomes,and the best method for patient evaluation was summarized.All data were input and analyzed statistically using SPSS25.0 software.Mann-Whitney rank sum test and Kruskal-Wallis rank sum test were used to investigate the basic data,gender differences and age distribution differences of various scores.Kappa consistency test was used to investigate whether there were differences in the assessment of patients’ disease by each of the three scoring methods.Mc Nemar-Bowker paired Chi-square test was used to investigate whether there were differences in the distribution of each of the three scores.Binary logistic regression analysis was used to observe the evaluation ability of the three scores on the outcome and severity of the disease,and the receiver operating characteristic curve(ROC)of the three scores of severe patients and patients with adverse outcomes was drawn,and the area under the ROC curve was calculated.The ability of simple MEWS score,MEWS II score and MEWS III score in evaluating the severity and outcome of patients’ disease was compared.Results:MEWS score,MEWS II score and MEWS III score showed basically no difference in the time spent in the triage process of emergency preexamination.The three scoring methods were consistent in evaluating the severity of patients’ critical illness.The grading of the three scores had statistical significance in the evaluation of the severity and outcome of patients with critical illness(P<0.05).The more severe the patient’s illness,the higher the likelihood of adverse outcomes,with the increase in the grading of patients by each assessment method.The MEWS II score was the most sensitive and had the largest area under the curve.Three grading scales were used to evaluate patient outcomes,with MEWS II having the highest sensitivity and the largest area under the curve.Conclusion:MEWS,MEWS II and MEWS III all have the ability to evaluate the severity and outcome of critical illness in emergency patients.However,the MEWS II score combined with St O2 of patients has a stronger monitoring ability of patients’ microcirculation oxygen saturation than Sp O2,which can detect patients’ microcirculation hypoxia status earlier,and then identify patients with potential risks.Therefore,MEWS II grading has a stronger ability to evaluate patients’ severity and outcome.The MEWS II scoring method can realize the rapid identification of critical patients during emergency pre-examination and triage,so as to optimize the allocation of medical resources in emergency department.