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Intensive care
Protocol
Early warning scores for detecting deterioration in adult hospital patients: a systematic review protocol
  1. Stephen Gerry1,
  2. Jacqueline Birks1,
  3. Timothy Bonnici2,
  4. Peter J Watkinson3,
  5. Shona Kirtley4,
  6. Gary S Collins1
  1. 1 Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
  2. 2 Nuffield Department of Medicine, University of Oxford, Oxford, UK
  3. 3 Kadoorie Centre for Critical Care Research and Education, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
  4. 4 UK EQUATOR Centre, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
  1. Correspondence to Stephen Gerry; stephen.gerry{at}csm.ox.ac.uk

Abstract

Introduction Early warning scores (EWSs) are used extensively to identify patients at risk of deterioration in hospital. Previous systematic reviews suggest that studies which develop EWSs suffer methodological shortcomings and consequently may fail to perform well. The reviews have also identified that few validation studies exist to test whether the scores work in other settings. We will aim to systematically review papers describing the development or validation of EWSs, focusing on methodology, generalisability and reporting.

Methods We will identify studies that describe the development or validation of EWSs for adult hospital inpatients. Each study will be assessed for risk of bias using the Prediction model Risk of Bias ASsessment Tool (PROBAST). Two reviewers will independently extract information. A narrative synthesis and descriptive statistics will be used to answer the main aims of the study which are to assess and critically appraise the methodological quality of the EWS, to describe the predictors included in the EWSs and to describe the reported performance of EWSs in external validation.

Ethics and dissemination This systematic review will only investigate published studies and therefore will not directly involve patient data. The review will help to establish whether EWSs are fit for purpose and make recommendations to improve the quality of future research in this area.

PROSPERO registration number CRD42017053324.

  • early warning scores
  • development
  • validation
  • risk of bias

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/bmjopen-2017-019268

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    Footnotes

    • Contributors SG, JB, TB, PJW and GSC conceived the study. SG developed the study protocol and will implement the systematic review under the supervision of GSC. SG will provide the study’s statistical analysis plan and will analyse the data. SG and SK will perform the study search and SG will screen and extract the data. JB, TB, PJW and GSC will review the work. SG wrote the first protocol manuscript draft and all authors gave input into and approved the final draft of the protocol.

    • Funding SG is funded by an NIHR Doctoral Fellowship (DRF-2016-09-073). JB, TB, PJW and GSC are supported by the NIHR Biomedical Research Centre, Oxford. The funders have not played any role in the development of this protocol.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement All unpublished data will be made available on request. The first author, SG, should be contacted with requests for unpublished data.