The effectiveness of physiologically based early warning or track and trigger systems after triage in adult patients presenting to emergency departments: a systematic review

Abstract

BackgroundChanges to physiological parameters precede deterioration of ill patients. Early warning and track and trigger systems (TTS) use routine physiological measurements with pre-specified thresholds to identify deteriorating patients and trigger appropriate and timely escalation of care. Patients presenting to the emergency department (ED) are undiagnosed, undifferentiated and of varying acuity, yet the effectiveness and cost-effectiveness of using early warning systems and TTS in this setting is unclear. We aimed to systematically review the evidence on the use, development/validation, clinical effectiveness and cost-effectiveness of physiologically based early warning systems and TTS for the detection of deterioration in adult patients presenting to EDs.MethodsWe searched for any study design in scientific databases and grey literature resources up to March 2016. Two reviewers independently screened results and conducted quality assessment. One reviewer extracted data with independent verification of 50% by a second reviewer. Only information available in English was included. Due to the heterogeneity of reporting across studies, results were synthesised narratively and in evidence tables.ResultsWe identified 6397 citations of which 47 studies and 1 clinical trial registration were included. Although early warning systems are increasingly used in EDs, compliance varies. One non-randomised controlled trial found that using an early warning system in the ED may lead to a change in patient management but may not reduce adverse events; however, this is uncertain, considering the very low quality of evidence. Twenty-eight different early warning systems were developed/validated in 36 studies. There is relatively good evidence on the predictive ability of certain early warning systems on mortality and ICU/hospital admission. No health economic data were identified.ConclusionsEarly warning systems seem to predict adverse outcomes in adult patients of varying acuity presenting to the ED but there is a lack of high quality comparative studies to examine the effect of using early warning systems on patient outcomes. Such studies should include health economics assessments.Electronic supplementary materialThe online version of this article (10.1186/s12873-017-0148-z) contains supplementary material, which is available to authorized users.

Oxygen Homeostasis and Mitochondrial Function in COVID-19 and ARDS Patients: The Ultimate Vital Signs

“…As of today, the monitoring of the respiratory and macrocardiovascular systems is well establish as presented in Figure 4. In addition to the measurements of up to 8 parameters that could be identified as vital signs, few groups developed a scoring systems that are based on the measured vital signs [86,88,[90][91][92][93][94][95].…”

Addressing overcrowding in an emergency department: an approach for identifying and treating influential factors and a real-life application

“…A patient's heart rate constitutes a quantifiable indication of his or her physical and mental state, which may reflect whether the patient requires further surveillance in the ED. For that reason, heart rate is also part of the emergency severity index (ESI) calculation method and is an early warning sign [34]. Once factors influencing ED crowding and patient length-of-stay are identified, scheduling-and-control models can be developed in order to predict changes in the availability of resources in real time and to indicate which steps should be taken to ensure that the ED provides more efficient service.…”

Developing outcome, process and balancing measures for an emergency department longitudinal patient monitoring system using a modified Delphi

“…It enables timely clinical intervention and transfer to a higher level of care in order to prevent adverse patient outcomes [4, 5]. A recent systematic review found that early warning systems ‘seem to predict adverse outcomes in adult patients of varying acuity presenting to the ED but there is a lack of high quality comparative studies to examine the effect of using early warning systems on patient outcomes’ [6]. There is also a lack of published measures for evaluating the effectiveness of longitudinal patient monitoring systems in the ED setting and the challenges of developing such measures have been outlined [7].…”