Jayasundera Romesh, Neilly Mark, Smith Toby O, Myint Phyo Kyaw
Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, Scotland, UK.
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK.
J Clin Med. 2018 Sep 28;7(10):309. doi: 10.3390/jcm7100309.
Early warning scores (EWSs) are used to identify deteriorating patients for appropriate interventions. We performed a systematic review to examine the usefulness of EWSs in predicting inpatient mortality and morbidity (transfer to higher-level care and length of hospital stay) in older people admitted to acute medical units with sepsis, acute cardiovascular events, or pneumonia.
A systematic review of published and unpublished databases was conducted. Cochrane's tool for assessing Risk of Bias in Non-Randomised Studies-of Interventions (ROBINS-I) was used to appraise the evidence. A narrative synthesis was performed due to substantial heterogeneity.
Five studies ( = 12,057) were eligible from 1033 citations. There was an overall "moderate" risk of bias for all studies. The predictive ability of EWSs regarding mortality was reported in one study ( = 274), suggesting EWSs were better at predicting survival, (negative predictive value >90% for all scores). Three studies ( = 1819) demonstrated a significant association between increasing modified EWSs (MEWSs) and increased risk of mortality. Hazards ratios for a composite death/intensive care (ICU) admission with MEWSs ≥5 were significant in one study ( = 0.003). Two studies ( = 1421) demonstrated that a MEWS ≥6 was associated with 21 times higher probability of mortality (95% Confidence Interval (CI): 2.71⁻170.57) compared with a MEWS ≤1. A MEWS of ≥5 was associated with 22 times higher probability of mortality (95% CI: 10.45⁻49.16).
Increasing EWSs are strongly associated with mortality and ICU admission in older acutely unwell patients. Future research should be targeted at better understanding the usefulness of high and increasing EWSs for specific acute illnesses in older adults.
早期预警评分（EWS）用于识别病情恶化的患者，以便采取适当干预措施。我们进行了一项系统评价，以检验EWS在预测入住急性内科病房的老年脓毒症、急性心血管事件或肺炎患者的住院死亡率和发病率（转至更高水平护理及住院时间）方面的有用性。
对已发表和未发表的数据库进行系统评价。使用Cochrane的非随机干预性研究偏倚风险评估工具（ROBINS - I）来评估证据。由于存在实质性异质性，进行了叙述性综合分析。
从1033篇文献中筛选出5项研究（n = 12,057）。所有研究总体存在“中度”偏倚风险。一项研究（n = 274）报告了EWS对死亡率的预测能力，表明EWS在预测生存方面表现更佳（所有评分的阴性预测值>90%）。三项研究（n = 1819）表明，改良早期预警评分（MEWS）升高与死亡风险增加之间存在显著关联。在一项研究中，MEWS≥5时复合死亡/重症监护病房（ICU）入住的风险比显著（n = 0.003）。两项研究（n = 1421）表明，与MEWS≤1相比，MEWS≥6时死亡概率高21倍（95%置信区间（CI）：2.71⁻170.57）。MEWS≥5时死亡概率高22倍（95% CI：10.45⁻49.16）。
在急性病情较重的老年患者中，EWS升高与死亡率及入住ICU密切相关。未来研究应致力于更好地理解高EWS及不断升高的EWS对老年特定急性疾病的有用性。
