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Current use of early warning scores in UK emergency departments
  1. James R Griffiths,
  2. Elizabeth M Kidney
  1. Barnsley Hospital NHS Foundation Trust, Department of Emergency, Barnsley, UK
  1. Correspondence to Dr James Griffiths, Barnsley Hospital NHS Foundation Trust, Gawber Road, Barnsley, South Yorkshire S75 2EP, UK; jamesgriffiths{at}


  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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The ability to detect emergency department (ED) patients at risk of physiological deterioration is crucial. A variety of triage tools has been developed to aid this decision-making, including the use of ‘track and trigger systems’. There is some evidence that early warning scores (EWS) can predict in-hospital mortality in ED patients1 2 but concerns remain that they are not sensitive enough to use as a risk assessment tool. This survey set out to assess the use of EWS in UK EDs and whether the respondent supported the use of EWS in the ED.


A postal survey was undertaken of 254 adult EDs within the UK. Questionnaires (see online appendix 1) were sent to the clinical lead at each department.


Responses were received from 145 departments, giving a response rate of 57%.

The responses to questions 1,3,4,5 and 7 are summarised in table 1.

Table 1

Answers to questions 1,3,4,5 and 7

The different types of EWS being used are highlighted in figure 1 and the responses about discharging patients with a high EWS can be seen in figure 2.

Figure 1

Different types of EWS currently used. MEWS, modified early warning scoring systems; PARS, patients at risk.

Figure 2

Discharging patients with a high early warning score.


A recent EMJ commentary by Roland and Coates3 argues that there is undoubtedly a need for an emergency department track and trigger system, but simply using an inpatient-derived model is potentially flawed. Many EDs will use the same system as the rest of their hospital to allow continuity of assessment throughout the patient stay but these systems have not been derived from or, in the most part, validated on ED patients. The multiplicity of risk assessment tools available presents a challenge to the acute clinician.4 In an attempt to derive a national early warning score, Prytherch et al,5 developed a scoring system (ViEWS) using a database of almost 200 000 observation sets and used 24 h mortality as their outcome measure. This study was based on adult inpatients but could be developed as an ED track and trigger system.


Despite the lack of strong evidence, the majority of UK EDs are using EWS in some form. Modified early warning scoring systems is the most commonly used but departments vary on their use of EWS for senior ED and/or critical care review. Over 90% of respondents in this survey support EWS in the ED.


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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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