Modified early warning score

Modified early warning score (MEWS) is a simple guide used by emergency medical services to quickly determine the risk of death of a subject. It is based on data derived from four physiological readings (systolic blood pressure, heart rate, respiratory rate, body temperature) and one observation (level of consciousness, AVPU). The resulting observations are compared to a normal range to generate a single score as follows:

Score	3	2	1	0	1	2	3
Systolic BP	<45%	30%	15% down	Normal for patient	15% up	30%	>45%
Heart rate (BPM)	—	<40	41-50	51-100	101-110	111-129	>130
Respiratory rate (RPM)	—	<9	—	9-14	15-20	21-29	>30
Temperature (°C)	—	<35	—	35.0-38.4	—	>38.5	—
AVPU	—	—	—	A	V	P	U

A score of five or more is clearly linked to increased likelihood of death and admission to a intensive care unit.

Leeds Teaching Hospitals Trust (LTHT) Guidelines 2011

The MEWS may differ according to various Trusts. The Leeds Teaching Hospitals use a scoring system as shown below (accurate as of February 2011)^[1]

Score	3	2	1	0	1	2	3
Systolic BP	<45%	<30%	15% down	Normal for patient	15% up	30% up	>45%
Heart rate (BPM)	<40	—	40-50	51-100	101-110	111-130	>130
Respiratory rate (RPM)	<8	—	8-11	12-20	21-25	26-30	>30
Oxygen Saturations (%)	<85	>85	>90	>94	—	—	—
Respiratory Support	CPAP BiPAP	>60%	O2	Nil	—	—	—
AVPU	—	—	—	Alert	Voice	Pain	Unconscious
Urine Output (mls)	<80	80-119	120-200	>200	>800	—	—
Pain Score	Severe	Moderate	Mild	None	—	—	—

References

• Subbe C.P., Kruger M., Gemmel L. - "Validation of a modified Early Warning Score in medical admissions." Quarterly Journal of Medicine 2001; 94; 521-6.

1. ^ Brown, H. (2010). Graded Response Observation Chart (Leeds Teaching Hospitals Trust - Revision date: November 2012)

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