• Anisa J N Jafar, Cornelia Junghans, Chun Shing Kwok, Chrissie Hymers, Kerri J Monk, Ed Gold, and Tim R Harris.
• aDepartment of Emergency Medicine bDepartment of Cardiology, University of Manchester, Manchester cDepartment of Emergency Medicine, Guys and St Thomas NHS Trust dDepartment of Emergency Medicine, Bart's Health NHS Trust eDepartment of Emergency Medicine, HEMS fDepartment of Medicine, Southend University Hospital gDepartment of Medical Education, Queen Mary University of London, London, UK.
• Eur J Emerg Med. 2016 Apr 1; 23 (2): 130-6.

ObjectiveWe 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 ParticipantsWe 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 MeasuresWe 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.ResultsIn 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.ConclusionThis 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.

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