Background: Early warning scoring systems (EWSS) such as Modified Early Warning Score (MEWS), National Early Warning Score (NEWS), Systemic Inflammatory Response Syndrome (SIRS), and Quick Sequential-Related Organ Failure Assessment (qSOFA) are used to predict patient deterioration in acute care settings. These systems monitor vital signs and laboratory results to identify at-risk patients.

Objective/Purpose: This systematic review assessed whether traditional scoring systems can accurately predict acute deterioration and mortality in adult inpatients compared to standard care.

Methods: We conducted a systematic review of case-control studies, cohort studies, and randomized control trials evaluating EWSS performance. MEDLINE was searched for English-language articles. Two authors independently assessed titles and abstracts, with a third reviewer resolving disagreements. Risk of bias was assessed using appropriate tools for each study design. Meta-analysis evaluated the relationship between scoring thresholds and mortality.

Results: Five studies met inclusion criteria from 92 initially identified. Studies utilized either NEWS (cutoffs ≥7-9) or MEWS (cutoffs ≥4-5) with sample sizes ranging from 151-35,800 participants. Meta-analysis revealed a positive correlation between higher EWSS scores and increased mortality. The Martin-Rodriguez study demonstrated the highest odds ratio with NEWS ≥9 cutoff. Significant heterogeneity was observed across studies.

Discussion/Conclusions: Despite limited evidence, preliminary findings suggest strong correlation between elevated warning scores and mortality. However, the evidence quality is compromised by significant methodological limitations and heterogeneity. While EWSS show promise for early identification of deteriorating patients, more robust research is needed to confirm their predictive accuracy and optimal implementation in clinical settings.