Challen et al reported the Pandemic Medical Early Warning Score (PMEWS) for triaging a patient with pandemic inflenza. This can help to identify a patient who may benefit from more aggressive management. The authors are from the University Hospital for the South Manchester NHS Foundation Trust.
Patient selection: symptoms of pandemic influenza (fever, cough, shortness of breath, sore throat, myalgia, watery diarrhea, etc)
Components:
(1) modified MEWS score of Subbe et al for physiologic data
(2) patient data (social factors)
Parameters for modified MEWS:
(1) systolic blood pressure
(2) heart rate in beats per minute
(3) respiratory rate in breaths per minute
(4) temperature in °C
(5) neurologic status
(6) oxygen saturation
Parameters for patient data:
(1) age in years
(2) social factors
|
Parameter for MEWS |
Finding |
Points |
|
systolic blood pressure |
<= 70 mm Hg |
3 |
|
|
71 - 90 mm Hg |
2 |
|
|
91 - 100 mm Hg |
1 |
|
|
> 100 mm Hg |
0 |
|
heart rate |
<= 40 beats per minute |
3 |
|
|
41 - 50 beats per minute |
2 |
|
|
51 - 100 beats per minute |
0 |
|
|
101 - 110 beats per minute |
1 |
|
|
111 - 129 beats per minute |
2 |
|
|
>= 130 beats per minute |
3 |
|
respiratory rate |
<= 8 breaths per minute |
3 |
|
|
9 to 18 breaths per min |
0 |
|
|
19 to 25 breaths per min |
1 |
|
|
26 to 29 breaths per min |
2 |
|
|
>= 30 breaths per minute |
3 |
|
temperature |
<= 35.0 °C |
2 |
|
|
35.1 to 36.0 °C |
1 |
|
|
36.1 to 37.9 °C |
0 |
|
|
38.0 to 38.9°C |
1 |
|
|
>= 39.0°C |
2 |
|
neurologic status |
alert |
0 |
|
|
confused or agitated |
1 |
|
|
responds to voice |
2 |
|
|
responds to pain or unresponsive |
3 |
|
oxygen saturation |
<= 89% |
3 |
|
|
90 to 93% |
2 |
|
|
94 to 96% |
1 |
|
|
> 96% |
0 |
where:
• The score differs from the previous score by the addition of oxygen saturation and different cutoffs for several of the parameters.
|
Parameter for Patient |
Finding |
Points |
|
age in years |
< 65 years |
0 |
|
|
>= 65 years |
1 |
|
social factor(s) |
social isolation (lives alone or has no fixed abode) |
1 |
|
|
chronic comorbid condition (respiratory, cardiac, renal diabetes, any cause of immunosuppression) |
1 |
|
|
performance status 3 to 5 |
1 |
|
|
none of the above |
0 |
where:
• The performance status ranged from 1 to 5 points (1 for normal activity without restriction; 2 for limited strenuous activity but can do light tasks; 3 for limited activity but normal self care; 4 for limited self-care; 5 bed or chair bound and unable to do self-care)
total for modified MEWS =
= SUM(points for all 6 parameters)
total patient or social score =
= SUM(points for both parameters)
Interpretation:
• minimum modified MEWS score: 0
• maximum modified MEWS score: 19
• minimum patient score: 0
• maximum patient score: 2
• maximum combination score: 21
• The higher the scores the more serious the patient's status.
