EARLY DETECTION OF CLINICAL DETERIORATION BY NURSING STAFF USING EARLY WARNING SCORES: IMPACT ON MORTALITY AND ADVERSE EVENTS

Abstract

DOI: https://doi.org/10.46296/yc.v10i19.0985

Abstract

Introduction: Early warning scores translate physiological changes and clinical monitoring signs into response thresholds. In inpatient settings, nursing staff play a central role by performing serial monitoring, calculating or validating scores, recognizing trajectories of deterioration, and initiating escalation of care. Objective: To synthesize available evidence regarding the impact of early detection of clinical deterioration—using nursing-administered early warning scores—on mortality, cardiorespiratory arrest, unplanned intensive care unit (ICU) admission, and other adverse events. Methods: A focused systematic review and update following PRISMA 2020 guidelines. Literature was searched up to April 30, 2026, in PubMed/MEDLINE, Scopus, SciELO, and Google Scholar; this was supplemented by reference tracking and cross-verification with a contemporary systematic review of NEWS/NEWS2. Priority was given to comparative or implementation studies with retrievable full text in which nursing staff directly participated in measurement, scoring, monitoring, communication, or escalation. Studies focused exclusively on prognosis without clinical implementation, abstracts lacking a full manuscript, and works focused solely on the ICU were excluded. Results: Thirteen primary full-text studies formed the basis of the synthesis. Evidence indicated that early warning systems improve the frequency and quality of monitoring and can reduce serious events when integrated with response protocols. A cluster trial involving 60,956 patients demonstrated improved monitoring and an association between protocol adherence and lower mortality. In a quasi-experimental study, NEWS reduced cardiorespiratory arrest (4.7% to 1.1%), unplanned ICU admission (5.3% to 1.7%), urgent surgery (6.3% to 0%), and acute kidney injury (6.8% to 1.1%). In contrast, some studies showed no significant changes in clinical outcomes, suggesting that scoring alone is insufficient. The systematic review of NEWS/NEWS2 published in 2026 estimated lower mortality (OR 0.79; 95% CI 0.66–0.94), albeit with very high heterogeneity and low certainty. Conclusions: Early warning scores support nursing surveillance and appear more effective when linked to a structured response, timely escalation, and a culture that allows for summoning help without hierarchical barriers. The evidence regarding mortality is favorable but of limited certainty; the effect is more consistent regarding monitoring processes, early recognition, and certain adverse events than for mortality alone.

Keywords: clinical deterioration; nursing; early warning score; NEWS; NEWS2; MEWS; mortality; patient safety; rapid response.