Modified early warning score and risk of mortality after acute stroke

Charles Knoery, Raphae S Barlas, Priya Vart, Allan B Clark, Stanley D Musgrave, Anthony K Metcalf, Diana J Day, Max O Bachmann, Elizabeth A Warburton, John F Potter, Phyo Kyaw Myint*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

1 Citation (Scopus)


OBJECTIVE: An accurate prediction tool may facilitate optimal management of patients with acute stroke from an early stage. We evaluated the association between admission modified early warning score (MEWS) and mortality in patients with acute stroke.

METHOD: Data from the Anglia Stroke Clinical Network Evaluation Study (ASCNES) were analysed. We evaluated the association between admission MEWS and four outcomes; in-patient, 7-day, 30-day and 1-year mortality. Logistic regression models were used to calculate the odds of all mortality timeframes, whereas Cox proportional hazards models were used to calculate mortality at 1 year. Five univariate and multivariate models were constructed, adjusting for confounders. Patients with a moderate (2-3) or high (≥4) scores were compared to patients with a low score (0-1).

RESULTS: The study population consisted of 2006 patients. A total of 1196 patients had low MEWS, 666 had moderate MEWS and 144 had a high MEWS. A high MEWS was associated with increased mortality as an in-patient (OR 4.93, 95 % CI: 2.88-8.42), at 7 days (OR 7.53, 95 % CI: 4.24-13.38), at 30 days (OR 5.74, 95 % CI: 3.38-9.76) and 1-year (HR 2.52, 95 % CI 1.88-3.39). At 1 year, model 5 had a 1.02 OR (95 % CI 0.83-1.24) with moderate MEWS and 2.52 (95 % CI 1.88-3.39) with high MEWS.

CONCLUSION: Elevated MEWS on admission is a potential marker for acute-stroke mortality and may therefore be a useful risk prediction tool, able to guide clinicians attempting to prognosticate outcomes for patients with acute-stroke.

Original languageEnglish
Article number106547
Number of pages5
JournalClinical neurology and neurosurgery
Publication statusPublished - 2021
Externally publishedYes


  • Aged
  • Aged, 80 and over
  • Early Warning Score
  • Female
  • Hemorrhagic Stroke/physiopathology
  • Hospital Mortality
  • Hospitalization
  • Humans
  • Ischemic Stroke/physiopathology
  • Logistic Models
  • Male
  • Middle Aged
  • Mortality
  • Multivariate Analysis
  • Proportional Hazards Models
  • Stroke/physiopathology

Cite this