Nydahl Peter, Jeitziner Marie-Madlen, Krotsetis Susanne, Kabir Koroush, Kuhlen Ralf, Braun Jan-Peter
Pflegewissenschaft und -entwicklung, Institut für Pflegewissenschaft und -praxis, Universitätsklinikum Schleswig-Holstein, UKSH Haus V40, Arnold-Heller-Str. 3, 24105, Kiel, Deutschland.
Paracelsus Medizinische Privatuniversität, Salzburg, Österreich.
Med Klin Intensivmed Notfmed. 2025 Jun 27. doi: 10.1007/s00063-025-01294-5.
Early warning scores (EWS) are used for monitoring and evaluating vital signs in hospitalized patients. With EWS, escalating measures for monitoring, consultation, and admission to intensive care units (ICU) can be initiated based on point values, potentially improving patient outcomes, (mostly mortality, ICU admission, sepsis, cardiac arrest). It remains unclear in which areas the implementation of EWS is most appropriate.
A rapid umbrella review including systematic reviews and meta-analyses, with searches conducted in CINAHL via EBSCO, OVID via Medline, Cochrane via Cochrane Library and LIVIVO via University Library Cologne, and data extraction in May 2024.
A total of 44 systematic reviews and 15 meta-analyses covering 542 individual studies with 57 different EWS versions in various settings/aspects such as methodology, patient outcome (sepsis, emergency departments, obstetrics, pediatrics), implementation, performance, and others were identified. Both the analysis results and the level of evidence from the analyses appear heterogeneous. EWS seem to be most effective in reducing risks in high-risk populations such as in emergency departments, geriatric trauma, medicine, and surgery, and possibly post-ICU patients. However, implementation requires extensive resources in terms of staff, structures, and processes to ensure quality improvement. Electronic aids such as monitoring systems, red flags in electronic patient records, and the use of artificial intelligence could significantly support implementation.
There is no general recommendation for or against the widespread introduction of EWS. EWS should first be implemented in high-risk areas, considering available staffing and material resources. Electronic systems could assist in implementation.
早期预警评分（EWS）用于监测和评估住院患者的生命体征。通过EWS，可以根据分值启动逐步升级的监测、会诊及重症监护病房（ICU）收治措施，这可能改善患者结局（主要是死亡率、ICU收治率、脓毒症、心脏骤停）。目前尚不清楚EWS在哪些领域的实施最为合适。
进行一项快速综合性综述，包括系统评价和荟萃分析，检索通过EBSCO的CINAHL、通过Medline的OVID、通过Cochrane图书馆的Cochrane以及通过科隆大学图书馆的LIVIVO进行，并于2024年5月进行数据提取。
共识别出44项系统评价和15项荟萃分析，涵盖542项个体研究，涉及57种不同版本的EWS，涉及方法学、患者结局（脓毒症、急诊科、产科、儿科）、实施、性能等各种设置/方面。分析结果和分析的证据水平均显示出异质性。EWS似乎在降低高风险人群（如急诊科、老年创伤、内科和外科患者，以及可能的ICU后患者）的风险方面最为有效。然而，实施需要在人员、结构和流程方面投入大量资源，以确保质量改进。诸如监测系统、电子病历中的警示标识以及人工智能的使用等电子辅助手段可以显著支持实施工作。
对于广泛引入EWS，没有普遍的支持或反对建议。应首先在高风险领域实施EWS，同时考虑现有的人员和物质资源。电子系统可以协助实施。
