Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Feb;9(2):116-9.
doi: 10.1002/jhm.2132. Epub 2013 Dec 19.

Measuring the modified early warning score and the Rothman index: advantages of utilizing the electronic medical record in an early warning system

G Duncan Finlay  1 , Michael J Rothman, Robert A Smith
Affiliations

Measuring the modified early warning score and the Rothman index: advantages of utilizing the electronic medical record in an early warning system

G Duncan Finlay et al. J Hosp Med. 2014 Feb.

Abstract

Early detection of an impending cardiac or pulmonary arrest is an important focus for hospitals trying to improve quality of care. Unfortunately, all current early warning systems suffer from high false-alarm rates. Most systems are based on the Modified Early Warning Score (MEWS); 4 of its 5 inputs are vital signs. The purpose of this study was to compare the accuracy of MEWS against the Rothman Index (RI), a patient acuity score based upon summation of excess risk functions that utilize additional data from the electronic medical record (EMR). MEWS and RI scores were computed retrospectively for 32,472 patient visits. Nursing assessments, a category of EMR inputs only used by the RI, showed sharp differences 24 hours before death. Receiver operating characteristic curves for 24-hour mortality demonstrated superior RI performance with c-statistics, 0.82 and 0.93, respectively. At the point where MEWS triggers an alarm, we identified the RI point corresponding to equal sensitivity and found the positive likelihood ratio (LR+) for MEWS was 7.8, and for the RI was 16.9 with false alarms reduced by 53%. At the RI point corresponding to equal LR+, the sensitivity for MEWS was 49% and 77% for RI, capturing 54% more of those patients who will die within 24 hours.

PubMed Disclaimer

Figures

FIG 1
FIG 1
Modified Early Warning Score (MEWS) and Rothman Index (RI). Shown are receiver operating characteristic curves for 24-hour hospital mortality of general medical-surgical unit patients (N = 32,472); area under the curve is MEWS = 0.82, RI = 0.93. (A) An alarm at MEWS = 4 corresponds to the cut point of RI = 16 for similar sensitivity (49.8%, 48.9%), resulting in 1 true positive for 18 false positives by MEWS, and for 8 false positives by RI. (B) Cut point at RI = 30 provides a positive predictive value (PPV) similar to MEWS = 4; these points of PPV (5.3%, 5.2%) result in 49% sensitivity by MEWS and 77% sensitivity by RI.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Subbe CP, Kruger M, Rutherford P, Gemmel L. Validation of a modified Early Warning Score in medical admissions. QJM Mon J Assoc Physicians. 2001;94:521–526. - PubMed
    1. Kyriacos U, Jelsma J, Jordan S. Monitoring vital signs using early warning scoring systems: a review of the literature. J Nurs Manag. 2011;19:311–330. - PubMed
    1. Kirkland LL, Malinchoc M, O'Byrne M. A clinical deterioration prediction tool for internal medicine patients. Am J Med Qual. 2013;28:135–142. - PubMed
    1. Prytherch DR, Smith GB, Schmidt PE, Featherstone PI. ViEWS—towards a national early warning score for detecting adult inpatient deterioration. Resuscitation. 2010;81:932–937. - PubMed
    1. Escobar GJ, LaGuardia JC, Turk BJ, Ragins A, Kipnis P, Draper D. Early detection of impending physiologic deterioration among patients who are not in intensive care: development of predictive models using data from an automated electronic medical record. J Hosp Med. 2012;7:388–395. - PubMed

Publication types