Abstract
Introduction
Despite the lack of robust evidence, numerous different track and trigger warning systems have been implemented. The MEWS (Modified Early Warning Score system) is one such example, and has not been validated in an emergency traumasetting. A considerable proportion of trauma admissions are elderly patients with co-morbidities. Early recognition of physiological deterioration and prompt action could therefore be lifesaving.
Aim
Identify whether the implementation of a MEWS system coupled with an outreach service had resulted in a reduction in the mortality within our unit.
Method
Retrospective study. The MEWS was implemented in 3 Trauma and Orthopaedic wards at the Leicester Royal Infirmary in the summer of 2005. The number of emergency trauma inpatient admissions and deaths from January 2002 to December 2009 were obtained. The diagnosis, primary procedures and cause of death, if known, were noted. Comparisons between pre and post MEWS implementation made.
Results
32,149 admissions (55% male; 45% female) with 889 deaths (67% female; 33% male, P< 0.0001.). 61% of admissions were due to proximal femoral fractures. The peak age of death was 71–80 years. A reduction has occurred in the mortality rate post-MEWS implementation in male (1.82 to 1.418; P=0.214), female (4.871 to 3.364; P=0.108) and total deaths (3.215 to 2.294; P=0.092), but this is not significant.
Conclusion
Mortality has not reduced since the introduction of MEWS to our trauma unit. In view of the apparent lack of clinical effectiveness of the MEWS/outreach partnership, we question the cost effectiveness of this initiative. Possible reasons may include: failure of the MEWS to be correctly applied; inadequate action once the threshold is triggered; or unsuitability of this tool for this patient population. A better system for identifying and treating trauma patients needs to be developed, which is suited to elderly patients with co-morbidities.
