Impact of point-of-care biomarkers on the improvement of the predictive capacity of early warning scores in prehospital care: a systematic review and meta-analysis

Objective.

The use of early warning scores and prehospital blood testing is a current reality in prehospital emergency medical systems. However, there is limited evidence regarding the benefit of incorporating point-of-care biomarkers alongside these scores. The aim of this study was to compare the predictive capacity of scores that include biomarkers with those based solely on vital signs.

Methods.

We conducted a systematic search across Medline (via PubMed), Web of Science, Cochrane Library, and Scopus databases for studies evaluating the ability of early warning scores and blood biomarkers to predict short-term mortality. A subsequent meta-analysis was performed to compare the effectiveness of scores based solely on physiological parameters with those incorporating analytical parameters.

Results.

A total of 9 studies were selected from the systematic review and included in the meta-analysis for meeting the predefined inclusion criteria. The pooled mean sensitivity was 0.619 (0.489–0.734) with biomarkers and 0.627 (0.538–0.708) without them; specificity was 0.809 (0.763–0.848) and 0.699 (0.653–0.742), and the diagnostic odds ratio was 6.839 (2.617–17.872) and 3.928 (2.811–5.491), respectively, for the scores with and without biomarkers. Significant differences were found for specificity (P < .001), but not for sensitivity (P = .917) or the odds ratio (P = .285).

Conclusions.

The inclusion of parameters derived from prehospital point-of-care testing in early warning scores provides a benefit to prehospital care, as it improves the identification of patients who will not experience short-termmortality by increasing specificity.