Early warning scores for detecting deterioration in adult hospital patients: a systematic review protocol

BMJ Open. 2017 Dec 3;7(12):e019268. doi: 10.1136/bmjopen-2017-019268.


Introduction: Early warning scores (EWSs) are used extensively to identify patients at risk of deterioration in hospital. Previous systematic reviews suggest that studies which develop EWSs suffer methodological shortcomings and consequently may fail to perform well. The reviews have also identified that few validation studies exist to test whether the scores work in other settings. We will aim to systematically review papers describing the development or validation of EWSs, focusing on methodology, generalisability and reporting.

Methods: We will identify studies that describe the development or validation of EWSs for adult hospital inpatients. Each study will be assessed for risk of bias using the Prediction model Risk of Bias ASsessment Tool (PROBAST). Two reviewers will independently extract information. A narrative synthesis and descriptive statistics will be used to answer the main aims of the study which are to assess and critically appraise the methodological quality of the EWS, to describe the predictors included in the EWSs and to describe the reported performance of EWSs in external validation.

Ethics and dissemination: This systematic review will only investigate published studies and therefore will not directly involve patient data. The review will help to establish whether EWSs are fit for purpose and make recommendations to improve the quality of future research in this area.

Prospero registration number: CRD42017053324.

Keywords: development; early warning scores; risk of bias; validation.

MeSH terms

  • Cardiopulmonary Resuscitation
  • Critical Care*
  • Critical Illness / therapy*
  • Critical Pathways*
  • Heart Arrest / therapy*
  • Hospital Rapid Response Team*
  • Humans
  • Inpatients
  • Outcome and Process Assessment, Health Care
  • Patient Safety
  • Severity of Illness Index
  • Systematic Reviews as Topic
  • Time Factors
  • Vital Signs