Early Warning Scores and Their Application in the Inpatient Oncology Settings

Sonieya Nagarajah, MD1; Monika K. Krzyzanowska, MD, MPH1,2; and Tracy Murphy, MBBCh, BAO1,2

1 Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
2 Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada


Early Warning Score (EWS) systems are tools that use alterations in vital signs to rapidly identify clinically deteriorating patients and escalate care accordingly. Since its conception in 1997, EWSs have been used in several settings, including the general inpatient ward, intensive care units, and the emergency department. Several iterations of EWSs have been developed with varying levels of sensitivity and specificity for use in different populations. There are multiple strengths of these tools, including their simplicity and their ability to standardize communication and to reduce inappropriate or delayed referrals to the intensive care unit. Although early identification of deteriorating patients in the oncology population is vital to reduce morbidity and mortality and to improve long-term prognosis, the application in the oncology setting has been limited. Patients with an oncological diagnosis are usually older, medically complex, and can have increased susceptibility to infections, end-organ damage, and death. A search using PubMed and Scopus was conducted for articles published between January 1997 and November 2020 pertaining to EWSs in the oncology setting. Seven relevant studies were identified and analyzed. The most commonly used EWS in this setting was the Modified Early Warning Score. Of the seven studies, only two included prospective validation of the EWS in the oncology population and the other five only included a retrospective assessment of the data. The majority of studies were limited by their small sample size, single-institution analysis, and retrospective nature. Future studies should assess dynamic changes in scores over time and evaluate balance measures to identify use of health care resources.

© 2022 by American Society of Clinical Oncology Published online January 07, 2022.

DOI: 10.1200/OP.21.00532 JCO Oncology Practice

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