Keywords: adult patients, deterioration, early warning score, general wards, modified early warning score, observations, vital signs


Background: Routine monitoring of patients’ clinical and physiological status by nurses includes the use of vital signs (observations) charts for recording findings. Charts that incorporate early warning score (EWS) systems are designed to ‘track’ signs of deterioration and ‘trigger’ a rapid response. Published studies of EWS systems are of limited benefit if reporting of these studies is inadequate. Reporting guidelines are recommended to improve the quality of reporting.Objective: To assess the adequacy of reporting studies on EWS systems.Methods: All study designs published between 1 May 2007 and 23 May 2015 describing the use of EWS systems for detecting deterioration in adult patients on general medical and surgical wards were included. Data extraction was undertaken by one researcher.Results: Of the 657 references identified from search terms, 596 articles were excluded leaving 61 articles for assessment. Most studies were published in non-nursing journals (47/61, 77.0%). Six of the 61 (9.8%) studies were reviews. The remaining 55 clinical studies on the use of EWS/MEWS systems were mostly observational (46/55, 83.6%) rather than experimental (9/55, 16.4%).Reporting guidelines were used in 9.8% (6/61) of reviewed studies. Only the reviews but no clinical studies reported a search strategy. Electronic searches included mostly CINAHL (5/6, 83.3%), MEDLINE and The Cochrane Library (4/6, 66.7%). No meta-analyses were performed. Inclusion and exclusion criteria and reasons for exclusion of references were well reported in the reviews.The most frequently reported range of physiological parameters (12/61, 19.7%) were respiratory rate, oxygen saturation, supplemental oxygen, heart rate, systolic blood pressure, temperature and level of consciousness.Conclusion: Reporting of published studies on EWS systems reviewed for this critical appraisal, with the exception of reviews, was inadequate as most did not use reporting guidelines, limiting the use of study findings for developing clinical guidelines and in further research. 

Author Biography

Una Kyriacos, University of Cape Town
Senior Lecturer


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