PONE-D-21-35942The Use of Early Warning System Scores in Prehospital and Emergency Department Settings to Predict Clinical Deterioration: A Systematic Review and Meta-AnalysisPLOS ONE

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PLOS ONE

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Additional Editor Comments:

The manuscript has been reviewed by two experts in the area. Both of them have favorable recommendations and comments. Based on their review reports, I recommend Minor Revision.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

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Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: I Don't Know

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This is the well compared study showing differences in hospital setting and pre hospital setting. We also use qSOFA for pre hospital and SOFA for emergency.As the study has used sepsis case and we are using SOFA or qSOFA to predict the outcome.Using this predictors also in the early warning score would have made more clear for the reader. As pre hospital setting has been used for patient treated by medical care personnel in this study .Cases from those category also referred when they become critical.And we usually understand the management in EMS while transporting patient to the definitive care center.So it would be good for reader if this has been clear in the initial part about pre hospital.

Reviewer #2: The authors have in their revised version adequately addressed the strengths and limitations in the submitted paper. Although the application of EWS in prehospital settings has many drawbacks and is problematic the authors have clearly stated the choice of thresholds, cut-off-points in different settings: The statement in the conclusion that EWS scores applied in the prehospital setting cannot accurately predict long-term events but can predict short term clinical decline puts the results of the systematic review/metaanalyses in the right perspective.

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Reviewer #1: No

Reviewer #2: No

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The Use of Early Warning System Scores in Prehospital and Emergency Department Settings to Predict Clinical Deterioration: A Systematic Review and Meta-Analysis

PONE-D-21-35942R1

Dear Dr. Guan,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Yong-Hong Kuo

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

The referees from the previous round have reviewed this revision. Both of them are satisfied with the revision and recommend Accept. Based on their comments and recommendations, I recommend Accept.

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: (No Response)

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: (No Response)

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: (No Response)

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: (No Response)

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: As an emergency physician i found it very useful in the ED.MEWS, and NEWS at cut-off points of 3, 4, or 6 had similar pooled diagnostic odds to predict 30-day mortality from this study. Further study with SOFA and APACHE II score will helps in ED in coming days.As predicting outcome is sepsis with NEWS and MEWS it also helps correlates with SOFA as diagnosis of sepsis according to Surviving Sepsis Campaign guideline from SOFA score.

Reviewer #2: (No Response)

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

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Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: Yes: Laxman Bhusal

Reviewer #2: No