Department of Medicine, Weston Area Health Trust, UK.
Department of Medicine, North Bristol NHS Trust, UK.
J Infect. 2018 Mar;76(3):241-248. doi: 10.1016/j.jinf.2018.01.002. Epub 2018 Jan 11.
Early Warning Scores are used to evaluate patients in many hospital settings. It is not clear if these are accurate in predicting mortality in sepsis. We performed a systematic review and meta-analysis of multiple studies in sepsis. Our aim was to estimate the accuracy of EWS for mortality in this setting.
PubMED, CINAHL, Cochrane, Web of Science and EMBASE were searched to October 2016. Studies of adults with sepsis who had EWS calculated using any appropriate tool (e.g. NEWS, MEWS) were eligible for inclusion. Study quality was assessed using QUADAS-2. Summary estimates were derived using HSROC analysis.
Six studies (4298 participants) were included. Results suggest that EWS cannot be used to predict which patients with sepsis will (positive likelihood ratio 1.79, 95% CI 1.53 to 2.11) or will not die (negative likelihood ratio 0.59, 95% CI 0.45 to 0.78). Two studies were rated as low risk of bias and one as unclear risk of bias on all domains. The other three studies were judged at high risk of bias in one domain.
Early Warning Scores are not sufficiently accurate to rule in or rule out mortality in patients with sepsis, based on the evidence available, which is generally poor quality.
预警评分系统被用于评估许多医院环境中的患者。但尚不清楚这些评分系统在预测脓毒症患者死亡率方面是否准确。我们对脓毒症相关的多项研究进行了系统回顾和荟萃分析。我们旨在评估预警评分系统在该环境下预测死亡率的准确性。
我们对截至 2016 年 10 月的 PubMED、CINAHL、Cochrane、Web of Science 和 EMBASE 进行了检索。纳入了使用任何合适工具（如 NEWS、MEWS）计算预警评分系统的成年人脓毒症患者的研究。使用 QUADAS-2 评估研究质量。使用 HSROC 分析得出汇总估计值。
共纳入了 6 项研究（4298 名参与者）。结果表明，预警评分系统不能用于预测哪些脓毒症患者会（阳性似然比 1.79，95%CI 1.53 至 2.11）或不会死亡（阴性似然比 0.59，95%CI 0.45 至 0.78）。有两项研究在所有领域被评为低偏倚风险，一项研究被评为不确定偏倚风险。另外三项研究在一个领域被评为高偏倚风险。
根据现有证据，预警评分系统的准确性还不足以用于排除或确诊脓毒症患者的死亡率，而这些证据的质量普遍较差。
