Do physiological scoring and a novel point of care metabolic screen predict 48-h outcome in admissions from the emergency department resuscitation area?

Objective We aimed to compare the performance of a widely used physiological score [Modified Early Warning Score (MEWS)] and a novel metabolic score (derived from a blood gas) in predicting outcome in emergency department patients. Design, setting and participants We carried out a prospective observational study using a convenience sample of 200 patients presenting to the resuscitation area of an inner-city teaching hospital over 4 months. Main outcome measures We looked primarily at whether either score predicted new organ failure at 48 h. Our secondary outcome measures were escalation of care and mortality at 48 h. Results In univariate analysis, MEWS and the metabolic score predicted 48-h organ failure [odds ratio (OR) 1.19, 95% confidence interval (CI) 1.04-1.35, P=0.009, and OR 1.34, 95% CI 1.015-1.56, P < 0.001, respectively]. Both MEWS and the metabolic score predicted 48-h death (OR 1.32, 95% CI 1.02-1.71, P=0.03, and OR 1.56, 95% CI 1.18-2.06, P=0.002, respectively) in univariate analysis. Neither predicted 48-h escalation of care. The metabolic score remained statistically significant at predicting organ failure or death after controlling for MEWS parameters (OR 1.35, 95% CI 1.13-1.62, P=0.001, and OR 1.74, 95% CI 1.13-2.69, P=0.01, respectively). In contrast, MEWS was no longer associated with these outcomes; however, our study has small participant numbers. Conclusion This pilot data suggest that a blood gas-derived metabolic score on emergency department arrival may be superior to MEWS at predicting organ failure and death at 48 h.