Evaluating the Role of the Modified Early Warning Score in Predicting Neurological Deterioration and Mortality in Acute Stroke
Joyce Jimenez Zambrano1, Praneeth Thadi1, Neville Alberto2
1Department of Neurology, University of North Dakota School of Medicine and Health Sciences & Sanford Health, 2University of North Dakota School of Medicine and Health Sciences & Sanford Health
Objective:
To evaluate the utility of the Modified Early Warning Score (MEWS) in predicting neurological deterioration and mortality in patients with acute stroke.
Background:
Stroke is the most common neurological emergency in the United States, associated with considerable morbidity and mortality. Therefore, the identification of a reliable scale to predict potential deterioration in patients presenting with acute stroke is crucial. The MEWS is a tool that uses 5 physiological parameters (systolic blood pressure, heart rate, respiratory rate, temperature and level of consciousness) to identify patients at risk for clinical decline.
Design/Methods:
This is a retrospective study of patients diagnosed with acute ischemic or hemorrhagic stroke admitted to a single comprehensive stroke center from January 2018 to October 2023. Data on demographics, initial MEWS, NIHSS, neurological deterioration, and mortality at 12 months were collected. Descriptive and logistic regression analyses were performed. Correlations between continuous variables were calculated using Pearson correlation coefficient. Significance was defined as a p-value <0.05.
Results:
A total of 103 patients were included (mean age 70±15.3), 48.5% of which were female. 75.7% of the patients had low MEWS (0-2), 15.5% had moderate MEWS (3-4), and 8.7% had a high MEWS (>5). Patients with a high MEWS had a higher 1-year mortality rate (OR 7.14, 95 % CI: 1.71–29.9, p=0.003) and were more likely to develop neurologic deterioration after the hospital admission (OR 15.9, 95 % CI: 3.02–83.1, p<0.001). There were strong positive correlations between initial MEWS and NIHSS (Pearson's r 0.761, p<0.001), and initial MEWS and modified Rankin Scale at 90 days (Pearson's r 0.589, p<0.001).
Conclusions:
This study found that a Modified Early Warning Score (MEWS) greater or equal than 5 upon admission may serve as a significant predictor of neurological deterioration and elevated 1-year mortality in patients presenting with acute stroke.
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