Monitoring vital signs using early warning scoring systems: a review of the literature


Una Kyriacos
Division of Nursing
School of Health Sciences
Faculty of Health Sciences
University of Cape Town
Cape Town 7925
South Africa


kyriacos u., jelsma j.&jordan s. (2011) Journal of Nursing Management 19, 311–330
Monitoring vital signs using early warning scoring systems: a review of the literature

Aim  To evaluate the need for, and the development and utility of, pen-and-paper (Modified) Early Warning Scoring (MEWS/EWS) systems for adult inpatients outside critical care and emergency departments, by reviewing published literature.

Background  Serious adverse events can be prevented by recognizing and responding to early signs of clinical and physiological deterioration.

Evaluation  Of 534 papers reporting MEWS/EWS systems for adult inpatients identified, 14 contained useable data on development and utility of MEWS/EWS systems. Systems without aggregate weighted scores were excluded.

Key issues  MEWS/EWS systems facilitate recognition of abnormal physiological parameters in deteriorating patients, but have limitations. There is no single validated scoring tool across diagnoses. Evidence of prospective validation of MEWS/EWS systems is limited; neither is implementation based on clinical trials. There is no evidence that implementation of Westernized MEWS/EWS systems is appropriate in resource-poor locations.

Conclusions  Better monitoring implies better care, but there is a paucity of data on the validation, implementation, evaluation and clinical testing of vital signs’ monitoring systems in general wards.

Implications for nursing management  Recording vital signs is not enough. Patient safety continues to depend on nurses’ clinical judgment of deterioration. Resources are needed to validate and evaluate MEWS/EWS systems in context.