Is the Modified Early Warning Score (MEWS) Superior to Physician & Nurse Judgement?

We’ve all noted the Modified Early Warning Score in our daily workflows.
But is this MEWS better than our clinical gestalt at predicting clinical illness?
That’s what these authors sought to sort out.
Hat tip to the authors. Read these data for yourself.
They performed a multicenter, prospective observational trial of all patients who presented to the ED via EMS.
Let’s just say that we kicked the butt of the Modified Early Warning Score.
800 patients were analyzed.
As with any test or score, we need to plot out how specific and sensitive it is.
To simply this, we use the area under the receiver operating curve.
ED nurses kicked the butt of the MEWS Score with an AUC of 0.809 vs. 0.73
Physicians also kicked the butt of the MEWS with an AUC of 0.848 vs. 0.73.
For the sake of statistical context, an AUC of 0.7 to 0.8 is considered acceptable.
This means that the MEWS is just acceptable.
Meanwhile, both nurses and physicians fall into the excellent category with an AUC between 0.8 to 0.9.
It’s also pretty neat that both physicians and nurses has equal skills sets in recognizing patients who are going to crash.
Do we really need all these pop-ups on our EMR or just good clinicians?
Nurses: can working with your friends improve outcomes?

Citation for MEWS

Kuit M, Veldhuis LI, Hollmann M, Nanayakkara P, Ridderikhof M. Recognition of Critically Ill Patients by Acute Healthcare Providers: A Multicenter Observational Study. Crit Care Med. 2023 Jun 1;51(6):697-705. doi: 10.1097/CCM.0000000000005839. Epub 2023 Mar 20. PMID: 36939246.
Link to Article and FULL FREE PDF

How to Support My Work

I have written “The Vasopressor & Inotrope Handbook: A Practical Guide for Healthcare Professionals,” a must-read for those in the field! You have several options to get a copy while supporting my endeavors. If you’re in the US, you can order directly from me with a special touch: A SIGNED COPY. Please note that I handle these shipments personally, so I appreciate your patience.

For quicker delivery or international orders, I recommend purchasing through Amazon. It is also available for KINDLE. When you use these affiliate links, I earn an additional commission at no extra cost to you, which is a great way to support my work.

Stay tuned for the audiobook version, which will soon be available on Audible. It’s an exciting addition that I’m eager to share with you!

I have started using Descript to edit my videos rather than just Final Cut Pro. I have found it to be extremely helpful at saving me time. CLICK HERE to give it a go.


Although great care has been taken to ensure that the information in this post is accurate, eddyjoe, LLC shall not be held responsible or in any way liable for the continued accuracy of the information, or for any errors, omissions or inaccuracies, or for any consequences arising therefrom.