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Modified Early Warning Score (EWS)

Purpose: To identify a patient on a general surgical ward who should be evaluated based on the modified Early Warning Score of Stenhouse et al.

Description

Stenhouse et al reported a modified early warning score (EWS) for identifying a critically ill patient on a general surgical ward. This can help to identify a patient who may require aggressive management. The authors are from Queen Hospital and Burton Hospitals in Burton on Trent in England.


 

This EWS is a modification of the one reported by Morgan et al.

 

Parameters:

(1) heart rate in beats per minute

(2) respiratory rate in breaths per minute

(3) body temperature in °C

(4) CNS status (AVPU)

(5) urine output in mL per kg per hour

(6) systolic blood pressure in mm Hg

 

Parameter

Finding

Points

heart rate

< 40

2

 

40 to 50

1

 

51 to 100

0

 

101 to 110

1

 

111 to 129

2

 

>= 130

3

respiratory rate

<= 8

3

 

9 to 14

0

 

15 to 20

1

 

21 to 29

2

 

>= 30

3

temperature

< 35.0°C

2

 

35.0 to 38.4°C

0

 

>= 38.5°C

2

CNS status

alert

0

 

responds to voice

1

 

responds to pain

2

 

unresponsive to all stimuli

3

urine output

none

3

 

< 1 mL per kg in 2 hours

2

 

< 1 mL per kg in 1 hour

1

 

> 3 mL per kg in 2 hours

1

systolic blood pressure

normal for patient

0

 

more than 45% lower than normal

3

 

30% lower than normal

2

 

15% lower than normal

1

 

15% above normal

1

 

30% above normal

2

 

> 45% above normal

3

 

where:

• The urine output could be ambiguous in certain circumstances. It might be clearer if "< 1 mL per kg in 1 hour" was "< 2 mL per kg in 2 hours". It is then needed to add an additional item for 2-3 mL in 2 hours, probably worth 0 points.

• There are gaps in the systolic blood pressure ranges.

 

modified EWS score =

= SUM(points for all 6 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 20

• The higher the score the more serious the patient's condition.

• A score >= 4 resulted in a review by the ward staff which could be followed by a response by the intensive care unit response team.

 


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Objective

ICD-10