Naylor David, Dicker Bridget, Howie Graham, Todd Verity
Paramedicine Research Unit, Paramedicine Department, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.
Clinical Audit and Research Team, Hato Hone St John, Auckland, New Zealand.
Emerg Med Australas. 2025 Jun;37(3):e70047. doi: 10.1111/1742-6723.70047.
Early Warning Scores (EWS) have been developed to identify patients at risk of deterioration. Although the application of EWS has become increasingly established in the prehospital setting, their use remains contentious. The aim of this systematic review is to summarise the most recent evidence on the predictive accuracy of the EWS for short-term mortality in adults in the prehospital setting. A systematic search was conducted using the Medline, CINAHL, and Scopus databases. Studies that evaluated the diagnostic accuracy of the prehospital Modified Early Warning Score, National Early Warning Score or National Early Warning Score 2 in predicting mortality were included. Secondary outcomes were intensive care unit (ICU) admission and hospital admission. The review included 16 studies published between 2012 and 2023, with the number of patients totalling 311 932. The literature indicated that prehospital EWS demonstrated a moderate to good diagnostic performance in predicting short-term mortality with an area under receiver operating characteristic curve ranging from 0.68 (95% confidence interval [CI]: 0.64-0.73) to 0.90 (95% CI: 0.82-0.97). Overall, diagnostic performance was higher for predicting mortality in short time frames (up to 48 h). The need to use relatively high cut-off points to identify at-risk patients may limit its use for the unselected patient populations found in the prehospital setting. The potential for under-triage and over-triage limits their use further. EWS should not replace structured clinical evaluation and judgement but may be useful as complementary and objective tools to aid the identification of patients at risk.
早期预警评分（EWS）已被开发用于识别有病情恶化风险的患者。尽管EWS在院前环境中的应用越来越广泛，但其使用仍存在争议。本系统评价的目的是总结关于EWS对院前环境中成人短期死亡率预测准确性的最新证据。使用Medline、CINAHL和Scopus数据库进行了系统检索。纳入了评估院前改良早期预警评分、国家早期预警评分或国家早期预警评分2在预测死亡率方面诊断准确性的研究。次要结局为重症监护病房（ICU）入院和住院。该评价纳入了2012年至2023年发表的16项研究，患者总数为311932人。文献表明，院前EWS在预测短期死亡率方面表现出中等至良好的诊断性能，受试者操作特征曲线下面积范围为0.68（95%置信区间[CI]：0.64 - 0.73）至0.90（95%CI：0.82 - 0.97）。总体而言，在预测短时间内（长达48小时）的死亡率时，诊断性能更高。需要使用相对较高的截断点来识别有风险的患者，这可能会限制其在院前环境中未经过筛选的患者群体中的应用。漏诊和误诊的可能性进一步限制了它们的使用。EWS不应取代结构化的临床评估和判断，但作为辅助识别有风险患者的补充性和客观性工具可能会有用。
