Evaluation of an Early Warning System in Adult Ward Patients: A Single-Center Retrospective Observational Study
Hande Güngör Danışan1, Ayşe Ince1, Cem Erdogan1, Tümay Uludağ Yanaral1, Pelin Karaaslan11Department of Anesthesiology and Reanimation, Faculty of Medicine, Istanbul Medipol University, Istanbul, Türkiye
Objectives: This study aimed to evaluate the clinical performance of the Early Warning System (EWS) in adult patients undergoing rapid response team (RRT) activation and to assess its association with intensive care unit (ICU) transfer, inhospital mortality, and code blue events. Methods: This retrospective observational study included adult patients who underwent RRT activation between 2020 and 2022. Demographic characteristics, EWS scores, response times, and clinical outcomes were analyzed. Univariate analyses, ROC curve analysis, and logistic regression were used to evaluate the predictive performance of EWS. Results: A total of 242 patients were included. The mean age was 57.4±17.0 years, and the mean EWS was 6.1±2.1. Following RRT assessment, 75.6% of patients continued ward-based follow-up, while 10.7% required ICU transfer. Blue code activation occurred in 1.7% of cases. Comparison of three-year periods before and after EWS implementation showed a 31.7% reduction in code blue events. EWS was not significantly associated with adverse outcomes, and ROC analysis demonstrated limited discriminative ability (AUC=0.525). Conclusion: EWS facilitates early recognition and timely escalation of care but demonstrates limited standalone prognostic performance, supporting its role as a decision-support tool alongside clinical judgment.
Cite This Article
Güngör Danışan H, Ince A, Erdogan C, Uludağ Yanaral T, Karaaslan P. Evaluation of an Early Warning System in Adult Ward Patients: A Single-Center Retrospective Observational Study. EJMI. 2026; 10(1): 25-31
Corresponding Author: Hande Güngör Danışan