JMIR Publications

ABSTRACT

Background:

Electronic early warning track-and-triage systems (EW/TTS) are crucial for patient monitoring, detecting clinical deterioration (CD), and activating rapid response teams. Understanding the current level of automation in EW/TTS is essential.

Objective:

Following a published registered study protocol, this systematic review provides a comprehensive overview and critical assessment of electronic EW/TTS, including automated features, algorithms, and technologies.

Methods:

Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we included studies from PubMed, Web of Science, and Scopus published between January 2010 and December 2025 describing EW/TTS applied in real-world settings and electronic systems for CD detection via vital sign monitoring, that monitor physiological data or other CD-related risk factors across settings and device types. We excluded studies outside the clinical context or those that used manual scoring charts. We applied a descriptive narrative approach and a methodological quality assessment according to the Joanna Briggs Institute (JBI) Critical Appraisal Checklist.

Results:

After removing outliers and duplicates, the query returned 1181 studies. The selected studies (n = 43) report CD as the primary objective (54.5%), with ICU transfer (23.5%) and mortality prediction (14.7%) as secondary objectives. EW/TTS primarily rely on vital signs and assessment scores, accounting for 62.7% of cases, to detect and predict CD effectively. 41.9% of systems have a measured automation level, 25.6% have a managed automation level, and 16.3% have a defined automation level. The studies focused on four technological domains, with a strong emphasis on data analytics (55.8%) and hardware technologies (16.3%). Machine learning was used in 25.6% of systems, achieving interoperability in 65.1%, enabling data exchange with electronic health records, other systems, and wearable devices through interoperability standards such as the HL7-developed FHIR standard and integration with communication platforms such as Ascom Unite. Evaluations of the systems showed earlier warning (20.0%), higher accuracy (17.1%), and lower specificity (12.9%) as the main reported outcomes. Electronic EW/TTS are the most prevalent in the USA (34.9%), UK (11.6%), and the Netherlands (9.3%).

Conclusions:

Current EW/TTS systems implement a measured level of automation and primarily focus on patient monitoring in hospital surgery wards. The primary objective of EW/TTS is to detect CD, while ICU transfer and predicting mortality serve as secondary objectives. EW/TTS predominantly rely on vital signs and assessment scores to detect and predict CD. The included studies primarily used data analytic technologies. More than half of EW/TTS feature data exchange capability and connectivity with other systems. Reported outcomes of EW/TTS include early warning, high accuracy, and lower specificity. As a limitation, we did not analyze high-quality, real-time vital signs in diverse environments, such as smart homes and smart vehicles. Using clinically validated wearable devices and establishing a standardized data collection framework may further improve system accuracy and reliability.