Pediatric anesthesia & critical care
The relationship between early warning scores at intensive care unit discharge and risk of intensive care unit readmission in adult and pediatric populations: a scoping review
Authors' conclusion
Most available studies report that higher EWS values at ICU discharge are associated with an increased likelihood of ICU readmission. Early warning scores may therefore serve as useful adjuncts to clinical judgement when assessing discharge readiness. Nevertheless, the current evidence base is limited by the absence of randomized or robust interventional trials, and substantial heterogeneity, which limits causal inference and the ability to determine whether EWS-guided discharge protocols improve outcomes. Further multicentre prospective studies are needed to determine whether EWS-guided discharge protocols improve patient outcomes, reduce readmissions, and optimize use of ICU resources.
Study context
- Population
- Adult and pediatric populations with early warning scores measured at or around the time of intensive care unit (ICU) discharge and unplanned ICU readmission following transfer to a hospital wardstudies met inclusion criteria · adult 14 · pediatric 6
- Participants
- 20 studies
- Outcome
- Association between higher EWS values at or near ICU discharge and increased risk of unplanned ICU readmission
Methodological detailswith support from a medical librarian, screening and data extraction performed in duplicate
- With support from a medical librarian
- Screening and data extraction performed in duplicate
Main finding
As reported in the abstract
- Studies reporting a significant association
- 17
- Studies finding no significant association
- three
Further findings
Study selection
- Records identified
- 7,977
- Records remaining after removal of duplicates
- 4,824
- Articles undergoing full-text review
- 58
Study designs
- All were observational (retrospective or prospective) or pre-post intervention designs; no randomized controlled trials were identified
Risk of bias (QUADAS-2)
- Generally low to moderate across QUADAS-2 domains, although several studies had high or unclear risk in key areas-most commonly patient selection and index test blinding-limiting causal inference
Original publication
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