Vital sign-based Early Warning Scores in low- and middle-income countries: a systematic review of clinical effectiveness and implementation challenges.

TL;DR

A systematic review of 5 studies found that early warning scores (EWS) implementation in low- and middle-income countries did not consistently improve mortality or serious adverse events, though some studies showed shorter hospital stays and reduced unplanned ICU admissions. Evidence certainty was low to moderate due to heterogeneous study designs and methodological limitations.

Key findings

• EWS implementation in LMICs showed no consistent reduction in mortality or serious adverse events across included studies
• Two studies reported shorter length of hospital stay post-implementation; one reported reduced unplanned ICU admissions
• Heterogeneity in study design, settings, and populations limited overall evidence quality
• Contextual barriers in LMICs including limited resources, insufficient training, and restricted escalation capacity may limit EWS effectiveness

Why this matters at the bedside

EWS are widely adopted in high-income countries but this review questions their effectiveness in resource-limited settings, suggesting that implementation alone without addressing contextual barriers may not improve key patient outcomes in LMICs.