Evaluation of an adjusted MEWS (Modified Early Warning Score) for COVID-19 patients to identify risk of ICU admission or death in the Kingdom of Bahrain

Jameela Al-Salman; Aysha Sanad Salem Alsabea; Safa Alkhawaja; Alia Mohammed Al Balooshi; Maryam Alalawi; Batool Abdulkarim Ebrahim; Jenan Hasan Zainaldeen; Adel Salman Al Sayyad

doi:10.1016/j.jiph.2023.09.002

Evaluation of an adjusted MEWS (Modified Early Warning Score) for COVID-19 patients to identify risk of ICU admission or death in the Kingdom of Bahrain

J Infect Public Health. 2023 Nov;16(11):1773-1777. doi: 10.1016/j.jiph.2023.09.002. Epub 2023 Sep 9.

Authors

Jameela Al-Salman¹, Aysha Sanad Salem Alsabea², Safa Alkhawaja³, Alia Mohammed Al Balooshi⁴, Maryam Alalawi⁵, Batool Abdulkarim Ebrahim⁶, Jenan Hasan Zainaldeen⁷, Adel Salman Al Sayyad⁸

Affiliations

¹ Senior Infectious Disease consultant King Hamad American medical Mission Salmaniya medical complex Associate professor of medicine, Arabian Gulf University. Electronic address: jsalman@health.gov.bh.
² Emergency medicine resident, Emergency Department, Salmaniya medical complex.
³ Senior Infectious Disease consultant Salmaniya medical complex.
⁴ Internal medicine resident, Internal medicine Department, Salmaniya medical complex.
⁵ Internal Medicine chief resident - specialist, Internal medicine Department, Salmaniya medical complex.
⁶ Pediatric specialist, Pediatric department, Salmaniya Medical Complex.
⁷ Pediatric resident, Pediatric department, Salmaniya medical complex, Wafa Fawzi Hassan Statistician, Infection Control Department, Salmaniya Medical Complex.
⁸ ABFM, Msc, DLSHTM Consultant Family Medicine, Epidemiology & Public Health Chief of Disease Control Section, Ministry of health Associate Prof. of Family and community Medicine, AGU.

PMID: 37738693
DOI: 10.1016/j.jiph.2023.09.002

Abstract

Background: While most COVID-19 cases have uncomplicated infection, a small proportion has the potential to develop life-threatening disease, as such development of a prediction tool using patients baseline characteristics at the time of diagnosis should aid in early identification of high-risk groups and devise pertinent management. Hence, we set up this retrospective study to determine preadmission triaging tool to predict the development of severe COVID-19 in the Kingdom of Bahrain MATERIALS AND METHODS: A retrospective study was conducted from 1 September 2020 to 30 November 2020 with enrolment of all SARS-CoV-2 PCR-confirmed persons aged ≥ 14 years who attended Al-Shamil Field Hospital (SFH) in the Kingdom of Bahrain for triaging and assessment with recording of the following parameters: systolic blood pressure, heart rate, respiratory rate, temperature, the alert, verbal, pain, unresponsive neurological score, age, oxygen saturation, comorbidities, Body Mass Index (BMI), duration of symptoms and living with immunocompromised populations to develop our local adjusted MEWS as predictor for ICU admission & for consideration of suitable isolation at home. Follow up data of all patients was obtained from the electronic medical records system including CXR findings, treatments/medications received, need of oxygen supplements /intubation, needs of ICU care, and the outcome (death /discharged alive) IBM SPSS statistic version 21 program was used for data analysis.

Results: Our study showed that using the locally developed adjusted MEWS score, there was an significant association between high value of this adjusted MEWS score and abnormal radiographic finding (49.7 % Vs. 17 % for patients with high score Vs. those with low score respectively). Out of the 181 patients with high scores on adjusted MEWS; 38.7 % required oxygen via nasal cannula, 14.4 % required face mask and 8.3 % non-rebreather mask; this proportion was significantly higher than their counterpart patients who score low on adjusted MEWS (20.9 %, 7.7 %, 4.8 %respectively) with statistically significance difference between the two groups (p value of 0.00, 0.00,.004 respectively) Requirement of ICU admission was significantly higher among patients with high score in comparison to those with low score (14.4 % vs. 3 %) with significant p value (0.00) But higher score value was not associated significantly with increase mortality rate among COVID patients.

Conclusion: Development of our new Adjusted MEWS score system by adding the additional elements of age, oxygen saturation, comorbidities, Body Mass Index (BMI) and duration of symptoms found to be very useful predictor tool for preadmission triaging of COVID patients based on their risk assessment to help clinician to decide on the appropriate placement to different level of isolation facilities.

Keywords: COVID-19; Isolation; MEWS score; Preadmission; Severe; Triage.