Early warning scales to track clinically deteriorating in emergency medical services: an integrative review
Abstract
Objective: To identify the scientific evidence in the literature on the use of early warning scales in the identification of adult and elderly patients in clinical deterioration in emergency medical services.
Methods: Integrative review, supported by the recommendation Preferred Reporting Items for Systematic Reviews and Meta-Analyses, with a search mnemonic based on the Populacion - Interest Phenomenon - Context (PICo) strategy, performed in the sources: US National Library of Medicine National Institutes Database Search of Health, Web of Science, SciVerse Scopus, Latin American and Caribbean Literature in Health Sciences and Cumulative Index to Nursing and Allied Health Literature. Rayyan was used in selection and content analysis to analyze the findings.
Results: 691 articles were identified, of which 22 composed the sample and 27 scales were listed, with emphasis on the National Early Warning Score, National Early Warning Score 2, Quick Sepsis Related Organ Failure Assessment and Modified Early Warning Score. The scales had similar assessment parameters, characterized by heart rate, respiratory rate, systolic blood pressure, temperature, oxygen saturation and level of consciousness.
Conclusion: 27 scales were listed with similar evaluation parameters, in which four were the most prevalent and of these the National Early Warning Score proved to be the most accurate, however evidence shows that the Modified Early Warning Score is the most used in emergency medical services.
Downloads
References
Endo T, Yoshida T, Shinozaki T, Motohashi T, Hsu H-C, Fukuda S, et al. Efficacy of prehospital National Early Warning Score to predict outpatient disposition at an emergency department of a Japanese tertiary hospital: a retrospective study. BMJ Open. 2020;10(6):e034602. doi: 10.1136 / bmjopen-2019-034602.
Ruangsomboon O, Boonmee P, Limsuwat C, Chakorn T, Monsomboon A. The utility of the rapid emergency medicine score (REMS) compared with SIRS, qSOFA and NEWS for Predicting in-hospital Mortality among Patients with suspicion of Sepsis in an emergency department. BMC Emerg Med. 2021;21(1):2. doi: 10.21203 / rs.3.rs-52232 / v1.
Skov MJ, Dynesen J, Jessen MK, Liesanth JY, Mackenhauer J, Kirkegaard H. Including oxygen supplement in the early warning score: a prediction study comparing TOKS, modified TOKS and NEWS in a cohort of emergency patients. Scand J Trauma Resusc Emerg Med. 2020;28(1):26. doi: 10.1186 / s13049-020-00720-1.
Spencer W, Smith J, Date P, Tonnerre E de, Taylor DM. Determination of the best early warning scores to predict clinical outcomes of patients in the emergency department. Emerg Med J. 2019;36(12):716–21. doi: 10.1136/emermed-2019-208622.
Skitch S, Tam B, Xu M, McInnis L, Vu A, Fox-Robichaud A. Examining the utility of the Hamilton early warning scores (HEWS) at triage: Retrospective pilot study in a Canadian emergency department. Canadian Journal of Emergency Medicine. 2018;20(2):266–74. doi: 10.1017 / cem.2017.21.
Considine J, Rawet J, Currey J. The effect of a staged, emergency department specific rapid response system on reporting of clinical deterioration. Australas Emerg Nurs J. [on line]. 2015;18(4):218–26. doi: 10.1016/j.aenj.2015.07.001.
Page MJ, McKenzie JE, Bussoyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372. doi: 10.1136/bmj.n71.
Mendes KDS, Silveira RC de CP, Galvão CM. Revisão integrativa: método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto contexto - enferm. 2008;17:758–64. doi: 10.1590/S0104-07072008000400018.
Sousa LMM, Marques JM, Firmino CF, Frade F, Valentim OS, Antunes AV. Modelos de formulação da questão de investigação na prática baseada na evidência. Revista investigação em enfermagem. [Internet] 2018 [cited 2021 Jan 18];(N Esp):31-39. Available from: https://www.researchgate.net/publication/325699143_MODELOS_DE_FORMULACAO_DA_QUESTAO_DE_INVESTIGACAO_NA_PRATICA_BASEADA_NA_EVIDENCIA
Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan—a web and mobile app for systematic reviews. Systematic Reviews. 2016;5(1):210. doi: 10.1186/s13643-016-0384-4.
Ursi ES, Gavão CM. Prevenção de lesões de pele no perioperatório: revisão integrativa da literatura. Rev Latino-Am Enfermagem. 2006;14:124–31. doi: 10.1590/S0104-11692006000100017.
Melnyk BM, Fineout-Overholt E, organizadores. Evidence-based practice in nursing & healthcare: a guide to best practice. Fourth edition. Philadelphia: Wolters Kluwer; 2019. 782 p.
Alencar DL, Marques APO, Leal MCC, Viera JCM. Fatores que interferem na sexualidade de idosos: uma revisão integrativa. Ciênc Saúde Coletiva. 2014;19(8):3.533-42. doi: 10.1590/1413-81232014198.12092013.
Aygun H, Eraybar S. The role of emergency department triage early warning score (TREWS) and modified early warning score (MEWS) to predict in-hospital mortality in COVID-19 patients. Ir J Med Sci.1-7, 2021. doi: 10.1007 / s11845-021-02696-y.
Prasad PA, Fang MC, Martinez SP, Liu KD, Kangelaris KN. Identifying the Sickest During Triage: Using Point-of-Care Severity Scores to Predict Prognosis in Emergency Department Patients With Suspected Sepsis. J Hosp Med. 2021;16(8):453–61. doi: 10.12788 / jhm.3642.
Martín-Rodríguez F, Martín-Conty JL, Sanz-García A, Rodríguez VC, Rabbione GO, Cebrían Ruíz I, et al. Early Warning Scores in Patients with Suspected COVID-19 Infection in Emergency Departments. J Pers Med. 2021;11(3):170. doi: 10.3390 / jpm11030170.
Carr E, Bendayan R, Bean D, Stammers M, Wang W, Zhang H, et al. Evaluation and improvement of the National Early Warning Score (NEWS2) for COVID-19: a multi-hospital study. BMC Med. 2021;19(1):23. doi: 10.1186 / s12916-020-01893-3.
López-Izquierdo R, Martín-Rodríguez F, Santos Pastor JC, García Criado J, Fadrique Millán LN, Carbajosa Rodríguez V, et al. Can capillary lactate improve early warning scores in emergency department? An observational, prospective, multicentre study. Int J Clin Pract. 2021;75(4):e13779. doi: 10.1111 / ijcp.137.
Covino M, Sandroni C, Santoro M, Sabia L, Simeoni B, Bocci MG, et al. Predicting intensive care unit admission and death for COVID-19 patients in the emergency department using early warning scores. Resuscitation. 2020;156:84–91. doi: 10.1016 / j.resuscitation.2020.08.124
Su Y, Ju M, Xie R, Yu S, Zheng J, Ma G, et al. Prognostic Accuracy of Early Warning Scores for Clinical Deterioration in Patients With COVID-19. Front Med (Lausanne). 2021;7:624255. doi: 10.3389 / fmed.2020.624255.
Viglino D, L’her E, Maltais F, Maignan M, Lellouche F. Evaluation of a new respiratory monitoring tool “Early Warning ScoreO2” for patients admitted at the emergency department with dyspnea. Resuscitation. 2020;148:59–65. doi: 10.1016/j.resuscitation.2020.01.004.
Martín-Rodríguez F, López-Izquierdo R, Delgado Benito JF, Sanz-García A, Del Pozo Vegas C, Castro Villamor MÁ, et al. Prehospital Point-Of-Care Lactate Increases the Prognostic Accuracy of National Early Warning Score 2 for Early Risk Stratification of Mortality: Results of a Multicenter, Observational Study. J Clin Med. 2020;9(4):E1156. doi: 10.3390/jcm9041156.
Dynesen J, Skov MJ, Mackenhauer J, Jessen MK, Liesanth JY, Ebdrup L, et al. The 7-day mortality associated with an early warning score varies between age groups in a cohort of adult Danish emergency department patients. Eur J Emerg Med. 2019;26(6):453–7. doi: 10.1097 / MEJ.0000000000000623.
Prabhakar SM, Tagami T, Liu N, Samsudin MI, Ng JCJ, Koh ZX, et al. Combining quick sequential organ failure assessment score with heart rate variability may improve predictive ability for mortality in septic patients at the emergency department. PLoS One. 2019;14(3):e0213445. doi: 10.1371 / journal.pone.0213445.
Redondo-González A, Varela-Patiño M, Álvarez-Manzanares J, Oliva-Ramos JR, López-Izquierdo R, Ramos-Sánchez C, et al. Assessment of the severity scores in patients included in a sepsis code in an Emergency Departament. Rev Esp Quimioter. 2018;31(4):316–22.
Keep JW, Messmer AS, Sladden R, Burrell N, Pinate R, Tunnicliff M, et al. National early warning score at Emergency Department triage may allow earlier identification of patients with severe sepsis and septic shock: a retrospective observational study. Emerg Med J. 2016;33(1):37–41. doi: 10.1136 / emermed-2014-204465.
So S-N, Ong C-W, Wong L-Y, Chung JYM, Graham CA. Is the Modified Early Warning Score able to enhance clinical observation to detect deteriorating patients earlier in an Accident & Emergency Department? Australas Emerg Nurs J. 2015;18(1):24–32. doi: 10.1016 / j.aenj.2014.12.001.
Jarvis SW, Kovacs C, Badriyah T, Briggs J, Mohammed MA, Meredith P, et al. Development and validation of a decision tree early warning score based on routine laboratory test results for the discrimination of hospital mortality in emergency medical admissions. Resuscitation. 2013;84(11):1494–9. doi: 10.1016 / j.resuscitation.2013.05.018.
Griffiths JR, Kidney EM. Current use of early warning scores in UK emergency departments. Emerg Med J. 2012;29(1):65–6. doi: 10.1136 / emermed-2011-200508
Fullerton JN, Price CL, Silvey NE, Brace SJ, Perkins GD. Is the Modified Early Warning Score (MEWS) superior to clinician judgement in detecting critical illness in the pre-hospital environment? Resuscitation. 2012;83(5):557–62. doi: 10.1016 / j.resuscitation.2012.01.004.
The works published in this magazine are subject to the following terms:
1. The Publications Service of the University of Murcia (the publisher) preserves the copyright of the published works, and encourages and allows the reuse of the works under the license for use stated in point 2.
© Servicio de Publicaciones, Universidad de Murcia, 2011 (© Publications Service, University of Murcia, 2011)
2. The works are published in the electronic edition of the journal under Creative Commons Reconocimiento-NoComercial-SinObraDerivada 3.0 España(texto legal) “ a Attribution-NonCommercial-NoDerivatives 3.0 Spain license (legal text)”. They can be copied, used, broadcasted, transmitted and publicly displayed, provided that: i) the authorship and original source of their publication (journal, publisher and URL) are cited; (ii) are not used for commercial purposes; iii) the existence and specifications of this license is mentioned.
3. Conditions of self-archiving. Authors are allowed and encouraged to electronically disseminate the pre-print (pre-reviewed ) and / or post-print (reviewed and accepted for publication) versions of their works prior to publication, as it ensures a wider circulation and dissemination which may lead to a possible increase in its mention and a higher scope among the academic community. RoMEO color: green.