Predicting Patient Deterioration: A Review of Tools in the Digital Hospital Setting

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Mann, Kay D
Good, Norm M
Fatehi, Farhad
Khanna, Sankalp
Campbell, Victoria
Conway, Roger
Sullivan, Clair
Staib, Andrew
Joyce, Christopher
Cook, David
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BACKGROUND: Early warning tools identify patients at risk of deterioration in hospitals. Electronic medical records in hospitals offer real-time data and the opportunity to automate early warning tools and provide real-time, dynamic risk estimates. OBJECTIVE: This review describes published studies on the development, validation, and implementation of tools for predicting patient deterioration in general wards in hospitals. METHODS: An electronic database search of peer reviewed journal papers from 2008-2020 identified studies reporting the use of tools and algorithms for predicting patient deterioration, defined by unplanned transfer to the intensive care unit, cardiac arrest, or death. Studies conducted solely in intensive care units, emergency departments, or single diagnosis patient groups were excluded. RESULTS: A total of 46 publications were eligible for inclusion. These publications were heterogeneous in design, setting, and outcome measures. Most studies were retrospective studies using cohort data to develop, validate, or statistically evaluate prediction tools. The tools consisted of early warning, screening, or scoring systems based on physiologic data, as well as more complex algorithms developed to better represent real-time data, deal with complexities of longitudinal data, and warn of deterioration risk earlier. Only a few studies detailed the results of the implementation of deterioration warning tools. CONCLUSIONS: Despite relative progress in the development of algorithms to predict patient deterioration, the literature has not shown that the deployment or implementation of such algorithms is reproducibly associated with improvements in patient outcomes. Further work is needed to realize the potential of automated predictions and update dynamic risk estimates as part of an operational early warning system for inpatient deterioration.

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Journal of Medical Internet Research

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© Kay D Mann, Norm M Good, Farhad Fatehi, Sankalp Khanna, Victoria Campbell, Roger Conway, Clair Sullivan, Andrew Staib, Christopher Joyce, David Cook. Originally published in the Journal of Medical Internet Research (, 30.09.2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on, as well as this copyright and license information must be included.

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Mann, KD; Good, NM; Fatehi, F; Khanna, S; Campbell, V; Conway, R; Sullivan, C; Staib, A; Joyce, C; Cook, D, Predicting Patient Deterioration: A Review of Tools in the Digital Hospital Setting, Journal of Medical Internet Research, 2021, 23 (9)