Methods: This study sample included all adult general practice unit inpatients sustaining an arrest, classified as requiring CPR and/or intubation at a 802-bed tertiary care, urban, teaching hospital from July 2014 through June 2015. Data extracted included MEWS variables at 4 hours (hr) and 24hr before an event. Time windows of 2-6hr and 20-28hr were used for the 4hr and 24hr windows respectively. For missing points, the closest retrospective value was taken, even if outside the desired range. Level of consciousness (Alert, Verbal, Pain, Unresponsive) was inferred based on the nursing, therapy, nutritional notes or if the recorded pain score was >0. The primary outcome was survival to hospital discharge. Univariate and multiple binary logistic regression models were used to assess the relationship between patient status at discharge and pre-code MEWS, adjusted for age, Charlson Comorbidity Index (CCI), and gender.
Results: A total of 216 patients experienced arrests during the study period. At discharge, 53.1% of patients survived. Baseline demographics and MEWS are summarized in Table 1 for each outcome group. The odds ratio of death for the MEWS at 4hr was 0.89 (95% CI 0.75-1.07; p-value 0.24) (Figure 1). In a binary logistic regression model using 4hr MEWS, CCI, age, and gender, the outcome of death was not associated with the 4hr MEWS, but was with age (OR 0.98, 95% CI 0.96-1, p = 0.041).
Conclusions: The MEWS has been associated with acute patient decompensation in the hospital, but in our study population, we did not find a relationship between the MEWS and patient survival at discharge following a code, even when adjusting for age and comorbidities. Events during the actual code event are known to affect survival, but were not evaluated in our study, which may contribute the negative result.
To cite this abstract:Cerasale, M; Starakiewicz, P; Parikh, M; Stanley, S; Mohtadi, O . CODE BLUE OUTCOMES: RELATION TO THE MODIFIED EARLY WARNING SCORE. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 96. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/code-blue-outcomes-relation-to-the-modified-early-warning-score/. Accessed September 20, 2019.