Early Warning Systems for Acute Respiratory Infections:ScopingReview of Global Evidence

Background: Early warning systems (EWSs) are tools that integrate clinical observations to identify patterns indicating increasedrisks of clinical deterioration, thus facilitating timely and appropriate interventions. EWSs can mitigate the impact of globalinfectious diseases by enhancing information exchange, monitoring, and early detection.Objective: We aimed to evaluate the effectiveness of EWSs in acute respiratory infections (ARIs) through a scoping review ofEWSs developed, described, and implemented for detecting novel, exotic, and re-emerging ARIs.Methods: We searched Ovid MEDLINE ALL, Embase, Cochrane Library (Wiley), and CINAHL (Ebsco). The search wasconducted 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 usedfor quality assessment.Results: From 5838 initial articles, 29 met the inclusion criteria for this review. Twelve studies evaluated the use of EWSswithin community settings, ranging from rural community reporting networks to urban online participatory surveillance platforms.Five studies focused on EWSs that used data from hospitalization and emergency department visits. These systems leveragedclinical and admission data to effectively detect and manage local outbreaks of respiratory infections. Two studies focused onthe effectiveness of existing surveillance systems, assessing their adaptability and responsiveness to emerging threats and howthey could be improved based on past performance. Four studies highlighted the integration of machine learning models to improvethe predictive accuracy of EWSs. Three studies explored the applications of national EWSs in different health care settings andemphasized their potential in predicting clinical deterioration and facilitating early intervention. Lastly, 3 studies addressed theuse of surveillance systems in aged-care facilities, highlighting the unique challenges and needs of monitoring and respondingto health threats in environments housing vulnerable populations. The CASP tool revealed that most studies were relevant, reliable,and of high value (score 6: 11/29, 38%; score 5: 9/29, 31%). The common limitations included result generalizability, selectionbias, and small sample size for model validation.Conclusions: This scoping review confirms the critical role of EWSs in enhancing public health responses to respiratoryinfections. Although the effectiveness of these systems is evident, challenges related to generalizability and varying methodologiessuggest a need for continued innovation and standardization in EWS development