David Naylor MPhil, Bridget Dicker PhD, Graham Howie PhD, Verity Todd PhD
{"title":"使用院前预警评分预测短期死亡率:一项系统综述","authors":"David Naylor MPhil, Bridget Dicker PhD, Graham Howie PhD, Verity Todd PhD","doi":"10.1111/1742-6723.70047","DOIUrl":null,"url":null,"abstract":"<p>Early Warning Scores (EWS) have been developed to identify patients at risk of deterioration. Although the application of EWS has become increasingly established in the prehospital setting, their use remains contentious. The aim of this systematic review is to summarise the most recent evidence on the predictive accuracy of the EWS for short-term mortality in adults in the prehospital setting. A systematic search was conducted using the Medline, CINAHL, and Scopus databases. Studies that evaluated the diagnostic accuracy of the prehospital Modified Early Warning Score, National Early Warning Score or National Early Warning Score 2 in predicting mortality were included. Secondary outcomes were intensive care unit (ICU) admission and hospital admission. The review included 16 studies published between 2012 and 2023, with the number of patients totalling 311 932. The literature indicated that prehospital EWS demonstrated a moderate to good diagnostic performance in predicting short-term mortality with an area under receiver operating characteristic curve ranging from 0.68 (95% confidence interval [CI]: 0.64–0.73) to 0.90 (95% CI: 0.82–0.97). Overall, diagnostic performance was higher for predicting mortality in short time frames (up to 48 h). The need to use relatively high cut-off points to identify at-risk patients may limit its use for the unselected patient populations found in the prehospital setting. The potential for under-triage and over-triage limits their use further. EWS should not replace structured clinical evaluation and judgement but may be useful as complementary and objective tools to aid the identification of patients at risk.</p>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 3","pages":""},"PeriodicalIF":1.7000,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.70047","citationCount":"0","resultStr":"{\"title\":\"Review article: Use of prehospital early warning scores to predict short-term mortality: A systematic review\",\"authors\":\"David Naylor MPhil, Bridget Dicker PhD, Graham Howie PhD, Verity Todd PhD\",\"doi\":\"10.1111/1742-6723.70047\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p>Early Warning Scores (EWS) have been developed to identify patients at risk of deterioration. Although the application of EWS has become increasingly established in the prehospital setting, their use remains contentious. The aim of this systematic review is to summarise the most recent evidence on the predictive accuracy of the EWS for short-term mortality in adults in the prehospital setting. A systematic search was conducted using the Medline, CINAHL, and Scopus databases. Studies that evaluated the diagnostic accuracy of the prehospital Modified Early Warning Score, National Early Warning Score or National Early Warning Score 2 in predicting mortality were included. Secondary outcomes were intensive care unit (ICU) admission and hospital admission. The review included 16 studies published between 2012 and 2023, with the number of patients totalling 311 932. The literature indicated that prehospital EWS demonstrated a moderate to good diagnostic performance in predicting short-term mortality with an area under receiver operating characteristic curve ranging from 0.68 (95% confidence interval [CI]: 0.64–0.73) to 0.90 (95% CI: 0.82–0.97). Overall, diagnostic performance was higher for predicting mortality in short time frames (up to 48 h). The need to use relatively high cut-off points to identify at-risk patients may limit its use for the unselected patient populations found in the prehospital setting. The potential for under-triage and over-triage limits their use further. EWS should not replace structured clinical evaluation and judgement but may be useful as complementary and objective tools to aid the identification of patients at risk.</p>\",\"PeriodicalId\":11604,\"journal\":{\"name\":\"Emergency Medicine Australasia\",\"volume\":\"37 3\",\"pages\":\"\"},\"PeriodicalIF\":1.7000,\"publicationDate\":\"2025-05-02\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.70047\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Emergency Medicine Australasia\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1111/1742-6723.70047\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"EMERGENCY MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Emergency Medicine Australasia","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/1742-6723.70047","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"EMERGENCY MEDICINE","Score":null,"Total":0}
Review article: Use of prehospital early warning scores to predict short-term mortality: A systematic review
Early Warning Scores (EWS) have been developed to identify patients at risk of deterioration. Although the application of EWS has become increasingly established in the prehospital setting, their use remains contentious. The aim of this systematic review is to summarise the most recent evidence on the predictive accuracy of the EWS for short-term mortality in adults in the prehospital setting. A systematic search was conducted using the Medline, CINAHL, and Scopus databases. Studies that evaluated the diagnostic accuracy of the prehospital Modified Early Warning Score, National Early Warning Score or National Early Warning Score 2 in predicting mortality were included. Secondary outcomes were intensive care unit (ICU) admission and hospital admission. The review included 16 studies published between 2012 and 2023, with the number of patients totalling 311 932. The literature indicated that prehospital EWS demonstrated a moderate to good diagnostic performance in predicting short-term mortality with an area under receiver operating characteristic curve ranging from 0.68 (95% confidence interval [CI]: 0.64–0.73) to 0.90 (95% CI: 0.82–0.97). Overall, diagnostic performance was higher for predicting mortality in short time frames (up to 48 h). The need to use relatively high cut-off points to identify at-risk patients may limit its use for the unselected patient populations found in the prehospital setting. The potential for under-triage and over-triage limits their use further. EWS should not replace structured clinical evaluation and judgement but may be useful as complementary and objective tools to aid the identification of patients at risk.
期刊介绍:
Emergency Medicine Australasia is the official journal of the Australasian College for Emergency Medicine (ACEM) and the Australasian Society for Emergency Medicine (ASEM), and publishes original articles dealing with all aspects of clinical practice, research, education and experiences in emergency medicine.
Original articles are published under the following sections: Original Research, Paediatric Emergency Medicine, Disaster Medicine, Education and Training, Ethics, International Emergency Medicine, Management and Quality, Medicolegal Matters, Prehospital Care, Public Health, Rural and Remote Care, Technology, Toxicology and Trauma. Accepted papers become the copyright of the journal.