Problem
Criteria
Is there a problem
priority?
Benefits & harms of the options
What is the overall
certainty of this evidence?
Judgements
Research evidence
○ No
○ Probably no
○ Uncertain
● Probably yes
○ Yes
○ Varies
○ No included studies
○ Very low
● Low
○ Moderate
○ High
The limited available data make impossible any
certainty.
Cardiac arrest incidence before vs. after PEWS
implementation:
0.57 vs. 0.30 cases / 1000 admissions
Mortality after CA:
○ Important
uncertainty or
variability
○ Possibly important
Is there important
uncertainty about how
much people value the
main outcomes?
uncertainty or
variability
○
Probably no
important uncertainty
of variability
● No important
uncertainty of
variability
○ No known
undesirable
67% vs. 39%
Certainty of evidence (GRADE): VERY LOW
Cardiopulmonary arrest incidence reduction after
PEWS implementation:
37% in the cardiology/nephrology Unit
25% in the general medical Unit
Certainty of evidence (GRADE): VERY LOW
Additional considerations
Criteria
Are the desirable
anticipated effects large?
Are the undesirable
anticipated effects small?
Are the desirable effects
large relative to
undesirable effects?
Judgements
○ No
○ Probably no
○ Uncertain
● Probably yes
○ Yes
○ Varies
○ No
○ Probably no
○ Uncertain
○ Probably yes
●Yes
○ Varies
○ No
○ Probably no
○ Uncertain
○ Probably yes
●Yes
○ Varies
Research evidence
It seems rationale that the desirable effects of
implementation of PEWS should be large, but no
evidence (direct/indirect) are available.
No data are available about the potential undesirable
effects of applying a warning score, but it can
assumed to be very low because it used to be based
on clinical or non-invasively obtained data.
Not accounted for is cost and impact of PEWs
implementation on health care systems
Additional considerations
Criteria
Resource use
Are the resources required
small?
Equity
Is the incremental cost
small relative to the net
benefits?
What would be the impact
on health inequities?
Judgements
Research evidence
○ No
○ Probably no
● Uncertain
○ Probably yes
○ Yes
○ Varies
○ No
○ Probably no
○ Uncertain
● Probably yes
○ Yes
○ Varies
○ Increased
○ Probably increased
○ Uncertain
● Probably reduced
○ Reduced
○ Varies
No data available, but one could surmise if uniformly
implemented, patients regardless of age, gender, race
and diagnosis would be screened
Additional considerations
Feasibility
Acceptability
Criteria
Is the option acceptable to
key stakeholders?
Is the option feasible to
implement?
Judgements
○ No
○ Probably no
○ Uncertain
● Probably yes
○ Yes
○ Varies
○ No
○ Probably no
○ Uncertain
○ Probably yes
● Yes
○ Varies
Research evidence
Additional considerations
Recommendation
Balance of
consequences
Undesirable consequences
clearly outweigh desirable
consequences in most
settings
Undesirable consequences
probably outweigh desirable
consequences in most
settings
The balance between desirable
and undesirable consequences
is closely balanced or
uncertain
Desirable consequences
probably outweigh
undesirable consequences in
most settings
Desirable consequences
clearly outweigh undesirable
consequences in most
settings
○
○
●
○
○
Type of recommendation
Recommendation
Justification
Subgroup considerations
Implementation
considerations
Monitoring and evaluation
Research possibilities
We recommend against offering this
option
We suggest not offering this
option
We suggest offering this
option
We recommend offering this
option
○
○
●
○