Table 6 Evidence table: Development and validation studies – Undifferentiated patient groups

Burch et al. (2008) [63], South Africa

Risk of bias: High

790

MEWS

Hospital admission

MEWS 0–2 (ref)

MEWS 3–4: RR 1.3 (95% CI 1.1 to 1.6)

MEWS ≥5: RR 1.7 (95% CI 1.5 to 2.0)

In-hospital mortality

MEWS 0–2 (ref)

MEWS 3–4: RR 2.8 (95% CI 1.7 to 4.8)

MEWS ≥5: RR 4.6 (95% CI 2.7 to 7.8)

Correia et al. (2014) [55], Portugal

Risk of bias: Unclear

65

EWS

Length of hospital stay & Mortality

Score at 24 h and 12 h seemed to predict both length of stay and mortality (p < 0.05). The EWS would have increased early medical attention by 40% if a threshold of ≥3 was used.

Dundar et al. (2015) [41], Turkey

Risk of bias: Low

671

MEWS

VIEWS

Hospitalisation

MEWS (≥3): AUROC 0.73 (95% CI 0.69–0.77)

VIEWS (≥6): AUROC 0.76 (95% CI 0.72–0.79)

In-hospital mortality

MEWS (≥4): AUROC 0.89 (95% CI 0.84–0.94)

VIEWS (≥8): AUROC 0.90 (95% CI 0.86–0.94)

Eick et al. (2015) [42], Germany

Risk of bias: Low

5730

MEWS

In-hospital mortality

AUROC: 0.71 (0.67–0.75; p < 0.001)

Graham et al. (2007) [56], Hong Kong

Risk of bias: Unclear (Conference abstract)

413

MEWS (>4)

In-hospital mortality

OR 8.3 (95% CI 1.1–60.4), p = 0.013

ED re-attendance within 48 h

OR 45.2 (95% CI 3.4–568.9), p < 0.0001

Heitz et al. (2010) [43], USA

Risk of bias: Low

280

MEWS Max (≥4)

MEWS plus

Need for higher level of care or mortality within 24 h

MEWS Max: AUROC 0.73 (95% CI, 0.66–0.79)

MEWS Plus: AUROC 0.76 (95% CI, 0.69–0.82)

Junhasavasdiku et al. (2012) [58], Thailand

Risk of bias: Unclear

381

MEWS

Mortality

MEWS at ED was associated with mortality (p < 0.001)

Naidoo et al. (2014) [62], South Africa

Risk of bias: High

265

TEWS

Discharge within 24 h of admission, admission to a ward, admission to an intensive care unit (ICU), and death in hospital.

TEWS <7: 53.7% discharged; no admitted to ICU; none died.

TEWS ≥7: 18.7% discharged; 3 admitted to ICU; 4 died

Olsson et al. (2003) [33], Sweden

Risk of bias: Low

1027

APACHE II

RAPS

REMS

Mortality

REMS: AUROC: 0.91 ± 0.02

RAPS: AUROC: 0.87 ± 0.02

APACHE II: AUROC: 0.90 ± 0.02

Olsson et al. (2004) [34], Sweden

Risk of bias: Low

11,751

RAPS

REMS

Mortality

RAPS: AUROC: 0.65 ± 0.02

REMS: AUROC: 0.85 ± 0.01

Subbe et al. (2006) [50], UK

Risk of bias: Low

(a) 53 unselected; (b): 49 ICU admission; (c): 49 ED admission, transferred to ward then ICU

MEWS (>2)

ASSIST (>3)

MET (=1)

MTS (orange or red)

Patients identified as critically ill (at risk of deterioration)

MTS: Sensitivity: (a) 15%; (b) 96%; (c) 65%

MEWS: Sensitivity (a): 8%; (b) 77%; (c) 55%

ASSIST: Sensitivity (a): 0%; (b) 22%; (c) 16%

MET: Sensitivity (a) 0%; (b) 2%; (c) 7%

Wang et al. (2016) [60], Taiwan

Risk of bias: Unclear

99

CCI

MEWS

Survival to discharge

CCI: Adjusted OR 0.57 (95% CI 0.38–0.84); p = 0.005

Peri-arrest MEWS: Adjusted OR 0.77 (95% CI 0.60–0.97); p = 0.028