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Early Warning Scoring Systems: A Systematic Review

Smith MEB, Chiovaro JC, O'Neil ME, Kansagara D, Quinones AR, Freeman M, Motuapuaka M, Slatore CG. Early Warning Scoring Systems: A Systematic Review. 2014 Jan 1; 1(1).


Early warning system (EWS) scores are tools used by hospital care teams to recognize the early signs of clinical deterioration in order to initiate early intervention and management, such as increasing nursing attention, informing the provider, or activating a rapid response or medical emergency team. These tools involve assigning a numeric value to several physiologic parameters (e.g., systolic blood pressure, heart rate, oxygen saturation, respiratory rate, level of consciousness, and urine output) to derive a composite score that is used to identify a patient at risk of deterioration. Most are based on an aggregate weighted system in which the elements are assigned different points for the degree of physiological abnormality. Observational studies suggest that patients often show signs of clinical deterioration up to 24 hours prior to a serious clinical event requiring an intensive intervention. Delays in treatment or inadequate care of patients on general hospital wards may result in increased admissions to the intensive care unit (ICU), increased length of hospital stay, cardiac arrest, or death. The purpose of the EWS scores is to ensure timely and appropriate management of deteriorating patients on general hospital wards. This is potentially a significant topic for the VA, as the Portland, Oregon VA Medical Center has implemented a Modified Early Warning System (MEWS) and there are plans to implement this nationally. This evidence review will be used by the Office of Nursing Services Clinical Practice Programs ICU Workgroup to develop guidelines for the development and implementation of EWS scores at facilities within the VA system and will be used to identify gaps in evidence that warrant further research.

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