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Early warning systems

Modified Early Warning Score (MEWS)

MEWS identifies patients at risk of deterioration in hospital wards. Enter vital signs and level of consciousness to generate the score and recommended escalation.

bpm

Points: 0

mmHg

Points: 0

breaths/min

Points: 1

°C

Points: 0

Points: 0

Component summary

  • Heart rate0
  • Systolic BP0
  • Respiratory rate1
  • Temperature0
  • AVPU0

Total MEWS

1

Typical range 0–14

Low risk – routine monitoring

MEWS 0–2 suggests relative stability. Continue standard vital sign observations and re-evaluate if clinical status changes.

Document escalation steps, frequency of observations, and reassessment times based on local protocols.

How to Use This Calculator

1

Enter current vital signs

Use the most recent measurements. Ensure accuracy before calculating to avoid false reassurance or over-escalation.

2

Assess level of consciousness

Use AVPU (Alert, responds to Voice, responds to Pain, Unresponsive). Document contributing factors (e.g., sedation).

3

Escalate according to policy

Act on trigger thresholds defined by your institution’s rapid response or outreach team protocols.

Formula

MEWS assigns 0–3 points to each parameter:

  • Heart rate (bpm): ≤40 (+2), 41–50 (+1), 51–100 (0), 101–110 (+1), 111–129 (+2), ≥130 (+3).
  • Systolic BP (mmHg): ≤70 (+3), 71–80 (+2), 81–100 (+1), 101–199 (0), ≥200 (+2).
  • Respiratory rate (breaths/min): ≤8 (+2), 9–14 (0), 15–20 (+1), 21–29 (+2), ≥30 (+3).
  • Temperature (°C): ≤35 (+2), 35.1–38.4 (0), ≥38.5 (+1).
  • AVPU: Alert (0), Voice (1), Pain (2), Unresponsive (3).

Total score is the sum of component points.

Full Description

The Modified Early Warning Score (MEWS) is an observation tool for hospital wards to detect patient deterioration early. It combines vital signs with consciousness level to trigger escalation pathways such as rapid response activation or ICU review.

MEWS improves situational awareness but cannot replace clinical judgement. Newer systems (NEWS2) add oxygen saturation and supplemental oxygen use, offering better performance. Institutions may customize thresholds; align with local policies when interpreting results.

Frequently Asked Questions

How often should MEWS be calculated?

Per local policy. Stable patients may require 4-hourly checks, while high scores mandate continuous monitoring or ICU transfer.

Does supplemental oxygen affect MEWS?

Not in traditional MEWS. Consider NEWS2, which includes oxygen saturation and supplemental oxygen scoring.

Can MEWS be used in pediatrics?

No. Use age-adjusted Pediatric Early Warning Scores (PEWS) for children.

What if a patient is sedated?

Document baseline consciousness level and sedation status. Sedation may invalidate AVPU scoring; involve anesthetic/critical care teams.