Early warning scores as tools for early sepsis recognition

Over the last two decades, EWS have become increasingly integrated into hospital safety frameworks worldwide [[10], [11], [12], [13]]. Tools such as the Modified Early Warning Score (MEWS), National Early Warning Score (NEWS), and NEWS2 aggregate routinely measured physiological parameters to identify patients at risk of adverse clinical outcomes [[10], [11], [12]].

Importantly, these tools are bedside physiological scoring systems that do not require laboratory investigations and can be applied using routinely collected vital-sign observations. Effective use of EWS requires consistent physiological observations, accurate score calculation and timely escalation of abnormal findings.

Within high-income healthcare systems, EWS are commonly linked to rapid response systems, escalation protocols and multidisciplinary deterioration pathways, facilitating earlier recognition of physiological decline, improved communication among healthcare professionals and timely escalation of care [10,13]. Since sepsis frequently presents initially through subtle physiological abnormalities, EWS may also function as practical screening instruments capable of supporting earlier identification of septic patients before the onset of irreversible organ dysfunction [[14], [15], [16]].

Although most EWS were developed and validated predominantly in resource-rich healthcare environments, increasing evidence suggests that they can provide clinically useful prognostic information in LMICs [[10], [11], [12]]. Recent systematic evidence on the performance of EWS in LMICs suggests that these tools generally demonstrate moderate to good discrimination for predicting mortality and adverse events, but their performance remains heterogeneous across settings [5,17]. This variability likely reflects differences in healthcare infrastructure, patient populations, escalation capacity, and local implementation [5,7].

These findings indicate that introducing Early Warning Systems into African healthcare settings should be supported by local validation, assessment of predictive performance and context-sensitive implementation strategies rather than assumptions that performance will automatically translate across healthcare environments.

The practical pathway through which EWS support early recognition and escalation of care in resource-constrained healthcare settings is summarised in Fig. 1.

Fig. 1: Conceptual pathway for Early Warning Score–guided recognition and escalation of suspected sepsis. Early Warning Scores pathway for recognition of clinical deterioration and escalation of care in resource-constrained African healthcare settings. Effective use depends on structured physiological observations, prompt communication, senior clinical review and initiation of appropriate sepsis management. EWS = Early Warning Score; NEWS2 = National Early Warning Score 2; SBAR = Situation, Background, Assessment, Recommendation.