Can early warning scores identify deteriorating patients in out-of-hospital settings?

29 October 2018

National Institute for Health Research (NIHR) CLAHRC West researchers have done a systematic review of studies on the use of early warning scores (EWS) in out-of-hospital settings, to understand how effective National Early Warning Scores (NEWS) and other EWS are at predicting when a patient’s condition is deteriorating. They found that high and low scores were good at predicting whether a patient was going to deteriorate or not. When patients had scores in the middle, it was harder to interpret whether patients would deteriorate.

The review aimed to find out how good these scoring systems, including NEWS, are at detecting patients with deteriorating health before they reach hospital, in settings such as ambulance services and care homes.

NEWS was developed by the Royal College of physicians in 2012 to standardise the different EWS already in use across the healthcare system.

The researchers included 17 studies in their systematic review. Sixteen studies were based on measurements taken by ambulance staff and one was in a community nursing home. Six different types of early warning score were examined.

No studies looked at whether patient outcomes are different in out-of-hospital settings using an early warning score, compared to those not using one. Further studies are needed to address this question and to evaluate EWS in other out-of-hospital settings.


Can early warning scores identify deteriorating patients in pre-hospital settings? A systematic review

Rita Patel, Manjula D Nugawela, Hannah B Edwards, Alison Richards, Hein Le Roux, Anne Pullyblank, Penny Whiting

Published in Resuscitation