Assessment of vital signs and renal function with Modified Early Warning Score on patients after ICU discharge: Clinical Trial


Zeinab Tabanejad (MSc), Marzieh Pazokian (PhD), Abbas Ebadi (PhD) Behavioral Sciences Research Center (BSRC), Nursing Faculty of Baqiyatallah University of Medical sciences, Tehran, Iran


Marzieh Pazokian (PhD), Email: Author)


The Modified Early Warning Score (MEWS) is a simple physiological scoring system, which can easily identify patients after ICU discharge at risk of deterioration in a busy ward was investigated. The Early Warning Score (EWS) is a tool for bedside evaluation based on five physiological parameters: systolic blood pressure, pulse rate, respiratory rate, temperature and AVPU score (A for 'alert', V for 'responsive to verbal stimulation', P for 'responsive to painful stimulation', U for 'unresponsive'). The ability of a modified EWS, including relative deviation from patients' normal blood pressure and urine output, to identify patients who would potentially benefit from intensive care.



This was a single blind two-group randomized controlled trial. A convenient sample of patients was selected from two teaching hospitals located in Tehran, Iran. Patients after ICU discharge were randomly allocated to either the experimental or the control groups. Patients in the experimental group checked with Modified Early Warning Score for post-ICU care. Patients in the control group received the routine care of the study setting. After the intervention, patients’ vital signs, level of consciousness, and renal function were measured. The study was conducted in 2014. We invited ten ICU nurses who had work experiences of more than fifteen years to evaluate the content validity of the data sheet. The reliability of the EWS had been previously determined by using the Guttman split-half method which yielded a correlation coefficient of 0.868. The sensitivity of the instrument has been reported to be 80%.



After the study, there were no significant differences between the study groups regarding heart rate, respiratory rate, systolic blood pressure, level of consciousness and renal function (P value > 0.05). Also, the study groups differed significantly in terms of body temperature.



Use of the Modified Early Warning Score system may aid close monitoring and identification of high-risk patients who require increased levels of care. However, given the contradiction among the studies, further studies are needed for providing clear evidence about the effectiveness of the Modified Early Warning Score on patients after ICU discharge.



Vital signs, renal function with, Modified Early Warning Score, ICU discharge, Nursing care