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Publication - Dr David Arnold

    Early warning scores do not accurately predict mortality in sepsis

    a meta-analysis and systematic review of the literature


    Hamilton, F, Arnold, D, Baird, A, Albur, M & Whiting, P, 2018, ‘Early warning scores do not accurately predict mortality in sepsis: a meta-analysis and systematic review of the literature’. Journal of Infection, vol 76., pp. 241-248



    Warning Scores are used to evaluate patients in many hospital settings.
    It is not clear if these are accurate in predicting mortality in sepsis. We performed a systematic review and meta-analysis of multiple studies in sepsis. Our aim was to estimate the accuracy of EWS for mortality in this setting.


    CINAHL, Cochrane, Web of Science and EMBASE were searched to October
    2016. Studies of adults with sepsis who had EWS calculated using any
    appropriate tool (e.g. NEWS, MEWS) were eligible for inclusion. Study
    quality was assessed using QUADAS-2. Summary estimates were derived
    using HSROC analysis.


    studies (4298 participants) were included. Results suggest that EWS
    cannot be used to predict which patients with sepsis will (positive
    likelihood ratio 1.79, 95% CI 1.53 to 2.11) or will not die (negative
    likelihood ratio 0.59, 95% CI 0.45 to 0.78). Two studies were rated as
    low risk of bias and one as unclear risk of bias on all domains. The
    other three studies were judged at high risk of bias in one domain.


    Warning Scores are not sufficiently accurate to rule in or rule out
    mortality in patients with sepsis, based on the evidence available,
    which is generally poor quality.

    Full details in the University publications repository