Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building St. James's University Hospital, University of Leeds, Leeds, LS9 7TF, United Kingdom.
Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building St. James's University Hospital, University of Leeds, Leeds, LS9 7TF, United Kingdom.
Int J Nurs Stud. 2017 Nov;76:106-119. doi: 10.1016/j.ijnurstu.2017.09.003. Epub 2017 Sep 13.
Early warning scores are widely used to identify deteriorating patients. Whilst their ability to predict clinical outcomes has been extensively reviewed, there has been no attempt to summarise the overall strengths and limitations of these scores for patients, staff and systems. This review aims to address this gap in the literature to guide improvements for the optimization of patient safety.
A systematic review was conducted of MEDLINE, PubMed, CINAHL and The Cochrane Library in September 2016. The citations and reference lists of selected studies were reviewed for completeness. Studies were included if they evaluated vital signs monitoring in adult human subjects. Studies regarding the paediatric population were excluded, as were studies describing the development or validation of monitoring models. A narrative synthesis of qualitative, quantitative and mixed- methods studies was undertaken.
232 studies met the inclusion criteria. Twelve themes were identified from synthesis of the data: Strengths of early warning scores included their prediction value, influence on clinical outcomes, cross-specialty application, international relevance, interaction with other variables, impact on communication and opportunity for automation. Limitations included their sensitivity, the need for practitioner engagement, the need for reaction to escalation and the need for clinical judgment, and the intermittent nature of recording. Early warning scores are known to have good predictive value for patient deterioration and have been shown to improve patient outcomes across a variety of specialties and international settings. This is partly due to their facilitation of communication between healthcare workers. There is evidence that the prediction value of generic early warning scores suffers in comparison to specialty-specific scores, and that their sensitivity can be improved by the addition of other variables. They are also prone to inaccurate recording and user error, which can be partly overcome by automation.
Early warning scores provide the right language and environment for the timely escalation of patient care. They are limited by their intermittent and user-dependent nature, which can be partially overcome by automation and new continuous monitoring technologies, although clinical judgment remains paramount.
预警评分被广泛用于识别病情恶化的患者。虽然它们预测临床结局的能力已经得到了广泛的评估，但还没有人试图总结这些评分在患者、医护人员和系统方面的总体优势和局限性。本综述旨在弥补这一文献空白，以指导改善患者安全的措施。
我们于 2016 年 9 月对 MEDLINE、PubMed、CINAHL 和 The Cochrane Library 进行了系统检索，并对入选研究的参考文献进行了全面检索。如果研究评估了成人患者的生命体征监测，则纳入研究。排除儿科人群的研究以及描述监测模型开发或验证的研究。对定性、定量和混合方法研究进行了叙述性综合分析。
共有 232 项研究符合纳入标准。从数据综合中确定了 12 个主题：预警评分的优势包括其预测价值、对临床结局的影响、跨专业应用、国际相关性、与其他变量的相互作用、对沟通的影响以及实现自动化的机会。其局限性包括敏感性、医护人员参与的必要性、对升级的反应的必要性、临床判断的必要性以及记录的间歇性。预警评分对患者恶化具有良好的预测价值，已被证明在各种专业和国际环境中都能改善患者结局。这部分归因于它们促进了医护人员之间的沟通。有证据表明，通用预警评分的预测价值逊于专科专用评分，并且通过添加其他变量可以提高其敏感性。它们也容易出现不准确的记录和用户错误，这可以通过自动化部分克服。
预警评分提供了及时升级患者护理的正确语言和环境。它们的间歇性和依赖用户的性质有限，这可以通过自动化和新的连续监测技术部分克服，但临床判断仍然至关重要。
