Stolze Annick, Woolley-Hendriks Tara N M, Bassa Yara, de Vries Ralph, Boer Christa, Noordzij Peter G
Department of Anesthesiology, Amsterdam University Medical Centre, VU University, Amsterdam, The Netherlands.
Department of Anesthesiology, Intensive Care and Pain management, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands.
Int J Nurs Stud Adv. 2024 Oct 28;7:100256. doi: 10.1016/j.ijnsa.2024.100256. eCollection 2024 Dec.
An early warning scoring system aims to detect clinical deterioration at an early stage and prevent failure-to-rescue in hospitalized patients. In this systematic review we studied the effect of an early warning scoring system on adverse outcome in surgical patients.
This review was conducted and reported according to PRISMA and the protocol of this review is registered at PROSPERO, under the registration number CRD42018107799. PubMed, Embase.com, CINAHL (Ebsco) and Wiley/Cochrane Library were searched from inception up to 20-06-2023 for randomized controlled trials and non-randomized studies of interventions. Studies were eligible for inclusion if the effect of an early warning scoring system using spot check monitoring was studied.
Eight articles were included, of which two were randomised controlled trials. The overall risk of bias was high. A statistically significant decrease in mortality was seen in three studies. Two studies reported a decrease in cardiopulmonary arrests, and three studies found a decrease in ICU-admissions. There was heterogeneity among studies regarding the types of complications that were reported.
The evidence in favor of an early warning scoring system to reduce complications and mortality in surgical patients is low, mainly due to a limited number of studies and poor study design. Well-designed trials are needed to investigate whether an early warning scoring system improves outcome in surgical patients.
早期预警评分系统旨在早期发现临床病情恶化，并预防住院患者的抢救失败。在本系统评价中，我们研究了早期预警评分系统对外科手术患者不良结局的影响。
本评价按照PRISMA进行并报告，本评价方案已在PROSPERO注册，注册号为CRD42018107799。检索了PubMed、Embase.com、CINAHL（Ebsco）和Wiley/Cochrane图书馆，从建库至2023年6月20日，查找干预措施的随机对照试验和非随机研究。如果研究了使用抽查监测的早期预警评分系统的效果，则该研究符合纳入条件。
纳入8篇文章，其中2篇为随机对照试验。总体偏倚风险较高。三项研究中观察到死亡率有统计学意义的下降。两项研究报告心肺骤停有所减少，三项研究发现重症监护病房（ICU）入院人数有所减少。关于所报告并发症的类型，各研究之间存在异质性。
支持早期预警评分系统降低外科手术患者并发症和死亡率的证据不足，主要原因是研究数量有限且研究设计不佳。需要设计良好的试验来研究早期预警评分系统是否能改善外科手术患者的结局。
