[Early warning scores: a rapid umbrella review].

Abstract

Background: Early warning scores (EWS) are used for monitoring and evaluating vital signs in hospitalized patients. With EWS, escalating measures for monitoring, consultation, and admission to intensive care units (ICU) can be initiated based on point values, potentially improving patient outcomes, (mostly mortality, ICU admission, sepsis, cardiac arrest). It remains unclear in which areas the implementation of EWS is most appropriate.

Methods: A rapid umbrella review including systematic reviews and meta-analyses, with searches conducted in CINAHL via EBSCO, OVID via Medline, Cochrane via Cochrane Library and LIVIVO via University Library Cologne, and data extraction in May 2024.

Results: A total of 44 systematic reviews and 15 meta-analyses covering 542 individual studies with 57 different EWS versions in various settings/aspects such as methodology, patient outcome (sepsis, emergency departments, obstetrics, pediatrics), implementation, performance, and others were identified. Both the analysis results and the level of evidence from the analyses appear heterogeneous. EWS seem to be most effective in reducing risks in high-risk populations such as in emergency departments, geriatric trauma, medicine, and surgery, and possibly post-ICU patients. However, implementation requires extensive resources in terms of staff, structures, and processes to ensure quality improvement. Electronic aids such as monitoring systems, red flags in electronic patient records, and the use of artificial intelligence could significantly support implementation.

Conclusion: There is no general recommendation for or against the widespread introduction of EWS. EWS should first be implemented in high-risk areas, considering available staffing and material resources. Electronic systems could assist in implementation.