JMIR Publications

ABSTRACT

Background:

Early Warning Systems (EWSs) are tools that integrate clinical observations to identify patterns indicating increased risks of clinical deterioration, thus facilitate timely and appropriate interventions. EWSs can mitigate the impact of global infectious diseases through enhance information exchange, monitoring, and early detection.

Objective:

To evaluate the effectiveness of EWSs, we conducted a scoping review of early warning systems developed, described, and implemented for detecting novel, exotic, and re-emerging acute respiratory infections.

Methods:

We searched Ovid MEDLINE® ALL and Embase, the Cochrane Library (Wiley), and CINAHL (Ebsco). The search was conducted on October 03, 2023. Studies that implemented EWSs for the detection of acute respiratory illnesses were included. Covidence was used for citation management, and a modified Critical Appraisal Skills Programme (CASP) checklist was used for the quality assessment.

Results:

From the 5,838 initial articles, 29 met the inclusion criteria for this review. Twelve studies evaluated the use of EWSs within community settings, ranging from rural community reporting networks to urban online participatory surveillance platforms. Five studies focused on EWSs that utilize data from hospitalization and emergency department visits. These systems leveraged clinical and admission data to effectively detect and manage local outbreaks of respiratory infections. Two studies focused on the effectiveness of existing surveillance systems, assessing their adaptability and responsiveness to emerging threats, and how they could be improved based on past performance. Four studies highlighted the integration of machine learning models to improve the predictive accuracy of EWSs. Three studies explored the applications of national EWS in different healthcare settings and emphasized its potential in predicting clinical deterioration and facilitating early intervention. Lastly, three studies addressed the use of surveillance systems in aged-care facilities, highlighting the unique challenges and needs of monitoring and responding to health threats in environments housing vulnerable populations. CASP revealed that a majority of studies were relevant, reliable and of high value (6, n= 11, 37.93% and 5, n= 9, 31.03%). Common limitations included the generalizability of results, selection bias, and small sample size for validation of models.

Conclusions:

This scoping review confirms the critical role of EWSs in enhancing public health responses to respiratory infections. Although the effectiveness of these systems is evident, challenges related to generalizability and varying methodologies suggest a need for continued innovation and standardization in EWS development.