Modified early warning score and risk of mortality after acute stroke

Knoery, Charles, Barlas, Raphae S., Vart, Priya, Clark, Allan B. ORCID:, Musgrave, Stanley D., Metcalf, Anthony K., Day, Diana J., Bachmann, Max O. ORCID:, Warburton, Elizabeth A., Potter, John F. and Myint, Phyo Kyaw (2021) Modified early warning score and risk of mortality after acute stroke. Clinical Neurology and Neurosurgery, 202. ISSN 0303-8467

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Objective:  An accurate prediction tool may facilitate optimal management of patients with acute stroke from an early stage. We evaluated the association between admission modified early warning score (MEWS) and mortality in patients with acute stroke. Method:  Data from the Anglia Stroke Clinical Network Evaluation Study (ASCNES) were analysed. We evaluated the association between admission MEWS and four outcomes; in-patient, 7-day, 30-day and 1-year mortality. Logistic regression models were used to calculate the odds of all mortality timeframes, whereas Cox proportional hazards models were used to calculate mortality at 1 year. Five univariate and multivariate models were constructed, adjusting for confounders. Patients with a moderate (2-3) or high (≥4) scores were compared to patients with a low score (0-1). Results:  The study population consisted of 2,006 patients. A total of 1196 patients had low MEWS, 666 had moderate MEWS and 144 had a high MEWS. A high MEWS was associated with increased mortality as an in-patient (OR 4.93, 95% CI: 2.88–8.42), at 7 days (OR 7.53, 95% CI: 4.24 – 13.38), at 30 days (OR 5.74, 95% CI: 3.38 – 9.76) and 1-year (HR 2.52, 95% CI 1.88 – 3.39). At 1 year, model 5 had a 1.02 OR (95% CI 0.83 – 1.24) with moderate MEWS and 2.52 (95% CI 1.88 – 3.39) with high MEWS. Conclusion:  Elevated MEWS on admission is a potential marker for acute-stroke mortality and may therefore be a useful risk prediction tool, able to guide clinicians attempting to prognosticate outcomes for patients with acute-stroke.

Item Type: Article
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
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Depositing User: LivePure Connector
Date Deposited: 10 Feb 2021 01:06
Last Modified: 20 Apr 2023 20:31
DOI: 10.1016/j.clineuro.2021.106547

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