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