The effect of early warning scoring systems on adverse outcome in surgical patients: A systematic review

Abstract

Background

An early warning scoring system aims to detect clinical deterioration at an early stage and prevent failure-to-rescue in hospitalized patients. In this systematic review we studied the effect of an early warning scoring system on adverse outcome in surgical patients.

Methods

This review was conducted and reported according to PRISMA and the protocol of this review is registered at PROSPERO, under the registration number CRD42018107799. PubMed, Embase.com, CINAHL (Ebsco) and Wiley/Cochrane Library were searched from inception up to 20-06-2023 for randomized controlled trials and non-randomized studies of interventions. Studies were eligible for inclusion if the effect of an early warning scoring system using spot check monitoring was studied.

Results

Eight articles were included, of which two were randomised controlled trials. The overall risk of bias was high. A statistically significant decrease in mortality was seen in three studies. Two studies reported a decrease in cardiopulmonary arrests, and three studies found a decrease in ICU-admissions. There was heterogeneity among studies regarding the types of complications that were reported.

Conclusions

The evidence in favor of an early warning scoring system to reduce complications and mortality in surgical patients is low, mainly due to a limited number of studies and poor study design. Well-designed trials are needed to investigate whether an early warning scoring system improves outcome in surgical patients.