Nomogram construction of the difference in MEWS combined with SPO 2 for predicting the condition of patients with unplanned enter to the rescue room- A multi-centre study

Purpose: Investigate the efficacy of the difference in Modified Early Warning Score (MEWS) (within admission to the Emergency rescue Room versus 1 h of admission to the emergency observation room) combined with Pulse Oxygen Saturation(SPO ₂ )in early risk screening for unplanned transfer to the Emergency Rescue Room༈UTER༉. Methods: We collected the vital sign data of patients who are UTER in the emergency department of three hospitals and explored the predictive power of the difference in MEWS combined with the peripheral oxygen saturation (SPO ₂ ) of patients when they are UTER by constructing a binary logistic regression model and nomogram. The prediction model is evaluated by ROC, AUC, calibration curve and other indicators. Results: The optimal cut-off value for predicting the difference in MEWS is 3.5, and the maximum value of Youden index is 0.761. When patients are unplanned to enter the resuscitation room, the first measured SPO ₂ (P = 0.027, OR = 0.97, 95%CI: 0.94-1.00) and the difference in MEWS (P < 0.001, OR = 53.26, 95%CI: 29.51–96.11) are independent risk factors for predicting the progression of their condition. The training set predictive models AUC is 0.890 (95% CI: 0.853–0.927) and the internal and external validation sets’ predictive models AUC are 0.957 (95% CI: 0.917–0.997) and 0.934 (95%CI: 0.871–0.997), respectively. Conclusions: When a patient is UTER, the SPO2 measured for the first time and the difference in MEWS are independent risk factors for predicting the progression of their disease. The prediction model and the nomogram constructed by this can well predict the risk of disease change of the patient and improve the attention and vigilance of clinicians and nursing staff to the patient's disease.