PREDICTIVE VALUE OF SHOCK INDEX AND MODIFIED EARLY WARNING SCORE (MEWS) IN PATIENTS PRESENTING WITH ACUTE POISONING TO THE EMERGENCY DEPARTMENT

Abstract

Background: Acute poisoning is a frequent medical emergency that requires rapid assessment to identify patients at risk of deterioration and death. In situations where toxicological confirmation is delayed, simple bedside scoring systems may aid early clinical decision-making. Objective: To assess the prognostic utility of the Shock Index (SI) and Modified Early Warning Score (MEWS) in patients presenting with acute poisoning to the emergency department. Materials and Methods: This retrospective observational study included patients with acute poisoning who presented to the emergency department between January 2022 and December 2023. SI was calculated as heart rate divided by systolic blood pressure, while MEWS was derived from vital signs and level of consciousness. The primary outcome was in-hospital mortality. Secondary outcomes included intensive care unit admission, need for mechanical ventilation, vasopressor support, clinical deterioration within 24 hours, and hospital length of stay. Predictive performance was evaluated using receiver operating characteristic analysis and logistic regression. Results: A total of 236 patients were analyzed, with an in-hospital mortality rate of 9.7%. Pesticide poisoning was the most common exposure and occurred more frequently among non-survivors. Both SI and MEWS were significantly higher in non-survivors. SI predicted mortality with an area under the curve (AUC) of 0.842 at a cut-off value of 1.08, whereas MEWS demonstrated superior discrimination (AUC 0.914) at a cut-off value of 6. Multivariable analysis identified both SI >1.08 and MEWS ≥6 as independent predictors of mortality. Conclusion: SI and MEWS are effective bedside tools for risk stratification in acute poisoning, with MEWS showing greater predictive accuracy. Their combined application may facilitate early triage and timely critical care intervention.