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Clinical predictors of physiological deterioration


To study the ability and the feasibility of the Modified Early Warning Score (MEWS) as a screening tool to predict the high-risk critically ill patients who may develop cardiorespiratory arrest, and to compare between the MEWS and the Simplified Acute Physiology Score II (SAPS II) regarding the sensitivity, specificity and more easy to be applied.


Randomized, prospective study in the critical care medicine department in the Cairo University Hospitals including 100 critically ill patients newly admitted to the ICU. The MEWS is calculated daily during the period of the stay in the ICU with determination of the score Max, and SAPS II is calculated during the first 24 hours.


The MEWS score max grade of 8 or more was associated with the highest rate of arrest at which the sensitivity was 78.9%, specificity was 93.5%, efficacy was 88.00%, with area under the curve (AUC) = 0.928. The SAPS II - Expanded grade of 50 or more was associated with the highest rate of arrest at which the sensitivity was 71.1%, specificity was 100%, efficacy was 89.00%, with AUC = 0.872. Comparing the MEWS and SAPS II reveals that the MEWS has more sensitivity but less specificity than SAPS II and efficacy is almost the same. Regarding the simplicity and applicability: MEWS is easier, faster and simpler.


The MEWS score is a useful screening tool to predict the high-risk patients who have high probability to develop cardiorespiratory arrest among the critically ill patients in the ICU. It is simple and practical, has more sensitivity than SAPS II and therefore should be recommended in clinical practice.


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Correspondence to M Shehata.

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Shehata, M., Hussein, A., Farouk, A. et al. Clinical predictors of physiological deterioration. Crit Care 14, P256 (2010).

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  • High Probability
  • Emergency Medicine
  • Screening Tool
  • Screen Tool
  • Medicine Department