eprintid: 10126121
rev_number: 17
eprint_status: archive
userid: 608
dir: disk0/10/12/61/21
datestamp: 2021-04-20 17:47:09
lastmod: 2022-08-17 13:40:24
status_changed: 2021-04-20 17:47:09
type: article
metadata_visibility: show
creators_name: Alhmoud, B
creators_name: Bonnici, T
creators_name: Patel, R
creators_name: Melley, D
creators_name: Williams, B
creators_name: Banerjee, A
title: Performance of universal early warning scores in different patient subgroups and clinical settings: a systematic review
ispublished: pub
subjects: UCH
divisions: UCL
divisions: B02
divisions: D14
divisions: GA3
divisions: DD4
note: This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
abstract: OBJECTIVE: To assess predictive performance of universal early warning scores (EWS) in disease subgroups and clinical settings.

DESIGN: Systematic review.


DATA SOURCES: Medline, CINAHL, Embase and Cochrane database of systematic reviews from 1997 to 2019.

INCLUSION CRITERIA: Randomised trials and observational studies of internal or external validation of EWS to predict deterioration (mortality, intensive care unit (ICU) transfer and cardiac arrest) in disease subgroups or clinical settings.

RESULTS: We identified 770 studies, of which 103 were included. Study designs and methods were inconsistent, with significant risk of bias (high: n=16 and unclear: n=64 and low risk: n=28). There were only two randomised trials. There was a high degree of heterogeneity in all subgroups and in national early warning score (I2=72%–99%). Predictive accuracy (mean area under the curve; 95% CI) was highest in medical (0.74; 0.74 to 0.75) and surgical (0.77; 0.75 to 0.80) settings and respiratory diseases (0.77; 0.75 to 0.80). Few studies evaluated EWS in specific diseases, for example, cardiology (n=1) and respiratory (n=7). Mortality and ICU transfer were most frequently studied outcomes, and cardiac arrest was least examined (n=8). Integration with electronic health records was uncommon (n=9).

CONCLUSION: Methodology and quality of validation studies of EWS are insufficient to recommend their use in all diseases and all clinical settings despite good performance of EWS in some subgroups. There is urgent need for consistency in methods and study design, following consensus guidelines for predictive risk scores. Further research should consider specific diseases and settings, using electronic health record data, prior to large-scale implementation.

PROSPERO REGISTRATION NUMBER: PROSPERO CRD42019143141.
date: 2021-05
date_type: published
publisher: BMJ
official_url: http://dx.doi.org/10.1136/bmjopen-2020-045849
oa_status: green
full_text_type: pub
language: eng
primo: open
primo_central: open_green
verified: verified_manual
elements_id: 1857720
doi: 10.1136/bmjopen-2020-045849
lyricists_name: Banerjee, Amitava
lyricists_name: Patel, Riyaz
lyricists_name: Williams, Bryan
lyricists_id: ABANE83
lyricists_id: RSPAT27
lyricists_id: BWILL10
actors_name: Bracey, Alan
actors_id: ABBRA90
actors_role: owner
full_text_status: public
publication: BMJ Open
volume: 11
number: 4
article_number: e045849
citation:        Alhmoud, B;    Bonnici, T;    Patel, R;    Melley, D;    Williams, B;    Banerjee, A;      (2021)    Performance of universal early warning scores in different patient subgroups and clinical settings: a systematic review.                   BMJ Open , 11  (4)    , Article e045849.  10.1136/bmjopen-2020-045849 <https://doi.org/10.1136/bmjopen-2020-045849>.       Green open access   
 
document_url: https://discovery.ucl.ac.uk/id/eprint/10126121/1/e045849.full.pdf