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Sunday, 19 October 2014

New words: 'Mewsing' on medical risk

'She's mewsing 6, doctor'.

New medical shorthand for an urgent message for the duty doctor, part of an 'escalation protocol'. The word 'mewsing' derives from Modified Early Warning Score (MEWS), a red flag system for identifying patients at risk of a rapid deterioration in their medical condition, either as assessed in the community by emergency medical services or by health professionals in hospital.

A recent systematic review of the value of early warning scores (EWS) concluded that "scores perform well for predicting cardiac arrest and death within 48 hours although the impact on (other) health outcomes and resource utilization remains uncertain ...".

Current forms of  Early Warning Scores (EWS) have their origins in the 1990s, arising from efforts aimed at development of a simple scoring system suitable for bedside application for identifying patients at increased risk of rapid deterioration in their medical condition, irrespective of the illness involved.

The EWS protocol describes a clinical pathway which starts with health workers making standard physiological measurements - systolic blood pressure, heart rate, respiratory rate, body temperature and level of consciousness.  If these recordings are outside the expected rates, the early warning score increases. The higher the score the greater the risk of worsening in the medical condition due e.g. to progression in infection, development of acute cardiac complication and other serious medical problems.

In response to a high EWS score practitioners are called to respond urgently to reassess the at risk patient and institute with appropriate escalation  in clinical treatment.

Modified Early Warning Score (MEWS) were later devised to improve identification of surgical and medical patients "at risk of catastrophic deterioration". Modified scores may for example include weighting for the level of saturation of oxygen in the blood, urine output and pain.

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