Research thesis on the accuracy of modified early warning score and Rapid emergency medicine score in predicting hospital outcome of patients admitted to medical emergency department in Gondar University Hospital, Northwest Ethiopia, 2023

Abstract

Introduction: Emergency care unlike other patient fields is dynamic, unpredictable and typically admit patients with a wide range of acuity levels, diverse clinical conditions, and undifferentiated or uncertain diagnoses. Catastrophic deterioration of patients in hospital is frequently preceded by documented deterioration of physiological parameters. Failure or delay of recognition and intervention in clinical deterioration are significant problems in healthcare management. Specifically in low-income countries mortality is more significant where there is also lack of essential drugs, limited health infrastructures, and understaffed and underfunded health‑care systems Objective: To assess the accuracy of modified early warning score (MEWS) and rapid emergency medicine score (REMS) in predicting hospital outcome. Methods: Institution based prospective, single-centered cohort study was conducted from august 1 to October 30 2023 G.C among All patients age >18 years old who were admitted to medical emergency department of university of Gondar hospital. Descriptive summary was presented by using proportions, means, figure and tables. Significance was determined using odds ratios with 95% confidence intervals and each score will be assessed in terms of discrimination. Discrimination was measured by the area under the receiver operating characteristic curve for MEWS and REMS. Sensitivity, specificity, Positive predictive value and Negative Predictive Value was also analyzed. Logistic regression analysis was used to determine the association between independent variables and the outcome variables. Level of significance was decided by using a p-value of 0.05. RESULT: Total of 417 patients included in the study and both Modified early warning score (MEWS) and Rapid Emergency Medicine Score (REMS) score was assessed upon admission. The mean of the total MEWS score of patients who died was 5.37 and the area under the curve (AUC) for MEWS is 0.722 (95%CI: 0.641-.80). With the cut point of 4 which has a sensitivity 71% and specificity of 67.5%. For REMS, the mean score of patients who died was 9.85. The area under the curve (AUC) for REMS is 0.76 (95%CI: 0.673-0.847) with the cut point of 9 which has a sensitivity of 61 % and specificity of 83.4%. CONCLUSION: Both MEWS and REMS score are good predictors of in hospital mortality. . .And we can use both score as a predictor of in hospital mortality