ArticleJournal of evaluation in clinical practice2026
Evaluating Modified Early Warning Score Compliance to Minimize Unnecessary Intensive Care Unit Admissions: A Descriptive Cross-Sectional Needs Assessment at a University Teaching Tertiary Care Centre to Inform Quality Improvement Implementation.
Article in Journal of evaluation in clinical practice, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundIntensive Care Unit (ICU) resources are scarce in low- and middle-income countries (LMICs), with a median of 0.7 beds per 100,000 population. The Modified Early Warning Score (MEWS) aids early identification of clinical deterioration and supports standardized escalation and ICU triage decisions to optimize critical-care resource use. However, adherence to MEWS protocols remains inconsistent. RESEARCH QUESTION: Does adherence to MEWS-based ICU admission criteria improve patient outcomes, and which admission categories/service lines contribute most to MEWS-threshold discordance?
methodsWe conducted a descriptive cross-sectional baseline needs assessment of 120 adult ICU admissions over 3 months at a university teaching tertiary referral centre in Pakistan. MEWS at ICU admission was compared against the prespecified admission threshold (MEWS ≥ 7) to quantify threshold compliance and to characterise sub-threshold admissions by admission category/service line. Mortality and ICU length of stay were analysed as secondary, exploratory outcomes using univariable logistic regression and correlation analyses, respectively.
resultsOnly 34.2% of ICU admissions met the prespecified MEWS threshold, while 65.8% were admitted despite sub-threshold scores, indicating substantial MEWS-threshold discordance. Discordance was most frequent in trauma-related/neurosurgical and major surgical admissions. Meeting the MEWS threshold was associated with worse survival (OR = 0.247; 95% CI: 0.111-0.548), consistent with higher illness severity among threshold-concordant admissions. This association was not adjusted for confounders due to the limited events and should be interpreted cautiously. MEWS showed minimal correlation with ICU length of stay (r = 0.05; p = 0.576).
conclusionIn this baseline needs assessment, ICU admissions frequently diverged from the prespecified MEWS threshold, suggesting that clinician discretion and service-line context commonly override score-based recommendations. These findings provide an institution-specific foundation for targeted quality improvement (protocol refinement, training, audit-feedback, decision support, and step-up/HDU pathways).
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