Evaluation of a simplified therapeutic intervention scoring system (TISS-28) and the modified early warning score (MEWS) in predicting physiological deterioration during inter-facility transport

• Published in: Resuscitation Vol. 76; no. 1; pp. 47 - 51
• Main Authors: Lee, Larry L.Y, Yeung, K.L, Lo, Wendy Y.L, Lau, Yvonne S.C, Tang, Simon Y.H, Chan, Jimmy T.S
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 01-01-2008; Elsevier
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Emergency; Emergency and intensive care: injuries, diseases due to physical agents. Diving. Drowning. Disaster medicine; Emergency and intensive care: techniques, logistics; En route; Female; Hong Kong; Humans; Intensive care medicine; Intensive care unit. Emergency transport systems. Emergency, hospital ward; Inter-facility transport; Male; Medical sciences; Modified early warning score; Patient Transfer; Prospective Studies; Risk Assessment; ROC Curve; Severity of Illness Index; Statistics, Nonparametric; Therapeutic intervention scoring system; Hong Kong; Modified early warning score; Therapeutic intervention scoring system; En route; Inter-facility transport; Intensive care; Treatment; Deterioration; Evaluation scale; Facility; Transport; Resuscitation
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/j.resuscitation.2007.07.005

Summary Introduction There is an emerging demand for inter-facility transport (IFT) of patients in recent years following changes in the healthcare framework in Hong Kong but this carries certain risks. Anticipation of possible deterioration of patients is important for patient safety and therefore risk stratification of patients before transport is important. Objective This study evaluated the simplified therapeutic intervention scoring system (TISS-28) and modified early warning score (MEWS) in predicting physiological deterioration en route. Methods This is a prospective single centre study of all emergency IFT for adult patients, excluding patients with obstetric conditions, occurring between 1 January 2005 and 30 June 2006. The severity of illness was quantified in terms of TISS-28 and MEWS. Mann–Whitney test and receiver operator characteristic (ROC) curves were used to illustrate and compare their performance. Results Among 102 patients requiring IFT, 28 had physiological deterioration en route (27%). The TISS-28 scores upon dispatch ranged from 5 to 34 with a mean of 16.5 ± 5.71 whereas MEWS ranged from 0 to 11 with a mean of 2.82 ± 2.01. The incidence of physiological deterioration en route was significantly greater with a higher MEWS score ( P = 0.001) but this was not seen with the TISS-28 score. The area under the ROC curve for the predictive value of MEWS was 0.71 which performed better than TISS-28 (area under the curve = 0.53). Conclusion IFT represents a group of patients with vast heterogeneity. TISS-28 is not a useful tool for risk stratification prior to transport. MEWS was able to identify patients at risk but was not ideal.