Performance of universal early warning scores in different patient subgroups and clinical settings: a systematic review
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 observati...
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| Language: | English |
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BMJ Publishing Group
2021-04-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/11/4/e045849.full |
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| author | Amitava Banerjee Riyaz Patel Bryan Williams Timothy Bonnici Baneen Alhmoud Daniel Melley |
| author_facet | Amitava Banerjee Riyaz Patel Bryan Williams Timothy Bonnici Baneen Alhmoud Daniel Melley |
| author_sort | Amitava Banerjee |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-5a815eee0f2144b98e0c2b3dfa3be7a7 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2021-04-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-5a815eee0f2144b98e0c2b3dfa3be7a72024-11-21T21:15:08ZengBMJ Publishing GroupBMJ Open2044-60552021-04-0111410.1136/bmjopen-2020-045849Performance of universal early warning scores in different patient subgroups and clinical settings: a systematic reviewAmitava Banerjee0Riyaz Patel1Bryan Williams2Timothy Bonnici3Baneen Alhmoud4Daniel Melley52 University College London Hospitals NHS Trust, London, UKInstitute of Cardiovascular Science, University College London, London, UKUniversity College London Hospitals NHS Trust, London, UKUniversity College London Hospitals NHS Foundation TrustInstitute of Health Informatics, University College London, London, UKBarts Health NHS Trust, London, UKObjective 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.https://bmjopen.bmj.com/content/11/4/e045849.full |
| spellingShingle | Amitava Banerjee Riyaz Patel Bryan Williams Timothy Bonnici Baneen Alhmoud Daniel Melley Performance of universal early warning scores in different patient subgroups and clinical settings: a systematic review BMJ Open |
| title | Performance of universal early warning scores in different patient subgroups and clinical settings: a systematic review |
| title_full | Performance of universal early warning scores in different patient subgroups and clinical settings: a systematic review |
| title_fullStr | Performance of universal early warning scores in different patient subgroups and clinical settings: a systematic review |
| title_full_unstemmed | Performance of universal early warning scores in different patient subgroups and clinical settings: a systematic review |
| title_short | Performance of universal early warning scores in different patient subgroups and clinical settings: a systematic review |
| title_sort | performance of universal early warning scores in different patient subgroups and clinical settings a systematic review |
| url | https://bmjopen.bmj.com/content/11/4/e045849.full |
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