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. 2023 Mar;10(1):60-67.
doi: 10.15441/ceem.22.339. Epub 2023 Jan 3.

A combination of the Modified Early Warning Score and the Korean Triage and Acuity Scale as a triage tool in patients with infection

Seung Ryu  1 , Se Kwang Oh  2 , Bong Kyu Lee  1 , So Young Jeon  1
Affiliations

A combination of the Modified Early Warning Score and the Korean Triage and Acuity Scale as a triage tool in patients with infection

Seung Ryu et al. Clin Exp Emerg Med. 2023 Mar.

Abstract

Objective: We evaluated the utility of the Korean Modified Early Warning Score (KMEWS), which combines the Modified Early Warning Score (MEWS) and the Korean Triage and Acuity Scale (KTAS), as a triage tool to screen for infection in patients who visit the emergency department.

Methods: We retrospectively reviewed data extracted from electronic medical records. Patients aged ≥18 years with an infection who were admitted to the hospital via the emergency department between January 2018 and December 2019 were eligible for inclusion. The KMEWS score was calculated as the sum of the KTAS level and the MEWS score. We generated receiver operating characteristic curves and determined the area under the receiver operating characteristic curve (AUC) for the KMEWS, KTAS, MEWS, and Mortality in Emergency Department Sepsis (MEDS) scales. The primary outcome was septic shock, and secondary outcomes were intensive care unit admission and in-hospital mortality.

Results: The AUC values (95% confidence interval) for predicting septic shock were as follows: KMEWS, 0.910 (0.902-0.918); MEWS, 0.896 (0.887-0.904); KTAS score, 0.809 (0.798-0.819); and MEDS, 0.927 (0.919-0.934). The AUC values (95% confidence interval) for predicting in-hospital mortality were as follows: KMEWS, 0.752 (0.740-0.764); MEWS, 0.717 (0.704-0.729); KTAS score, 0.764 (0.752-0.776); and MEDS, 0.844 (0.834-0.854). The AUC values (95% confidence interval) for predicting intensive care unit admission were as follows: KMEWS, 0.826 (0.816-0.837); MEWS, 0.782 (0.770-0.793); KTAS score, 0.821 (0.810-0.831); and MEDS, 0.839 (0.829-0.849).

Conclusion: The KMEWS, which is a combination of the MEWS and the KTAS scores, might be a useful triage tool in emergency department patients who present with infection, particularly for predicting septic shock.

Keywords: Critical care; Hospital emergency service; Mortality; Septic shock; Triage.

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Conflict of interest statement

CONFLICT OF INTEREST

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
A flowchart of the study. Infection-related diagnosis was confirmed using the relevant International Classification of Diseases, 10th Revision codes in the medical records. ED, emergency department.
Fig. 2.
Fig. 2.
An analysis of the receiver operating characteristic curves for predicting septic shock. The areas under the receiver operating characteristic curve (AUC) of the models were calculated and tested mutually for significance using DeLong equality tests. The Korean Modified Early Warning Score (KMEWS) is the sum of the Korean Triage and Acuity Scale (KTAS) score and the Modified Early Warning Score (MEWS) score. MEDS, Mortality in Emergency Department Sepsis; CI, confidence interval.
Fig. 3.
Fig. 3.
An analysis of the receiver operating characteristic curves for predicting in-hospital mortality. The areas under the receiver operating characteristic curve (AUC) of the models were calculated and tested mutually for significance by DeLong equality tests. The Korean Modified Early Warning Score (KMEWS) is the sum of the Korean Triage and Acuity Scale (KTAS) score and the Modified Early Warning Score (MEWS) score. MEDS, Mortality in Emergency Department Sepsis; CI, confidence interval.
Fig. 4.
Fig. 4.
An analysis of the receiver operating characteristics curves for predicting intensive care unit admission. The areas under the receiver operating characteristic curve (AUC) of the models were calculated and tested mutually for significance using DeLong equality tests. The Korean Modified Early Warning Score (KMEWS) is the sum of the Korean Triage and Acuity Scale (KTAS) score and the Modified Early Warning Score (MEWS) score. MEDS, Mortality in Emergency Department Sepsis; CI, confidence interval.
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