Waterlow score for risk assessment in surgical patients: a systematic review

The Waterlow score (WS) is used routinely in clinical practice to assess risk of pressure sore development. Recent studies have also suggested its use in preoperative risk stratification. The primary aim of this systematic review was to evaluate the current evidence on the WS in predicting morbidity and mortality in surgical patients.

A systematic review was carried out in accordance with PRISMA and SWiM guidelines. A search strategy was conducted on the MEDLINE and EMBASE databases. Quality was assessed using the Newcastle-Ottawa scale.

Overall, 72 papers were identified, of which 7 met inclusion criteria for full text review, and 4 were included for analysis. All studies were cohort in nature and published between 2013 and 2016, encompassing a total of 505 surgical patients. The studies included general, vascular, transplant and orthopaedic surgery. A high WS was demonstrated to have statistically significant association with increased morbidity and mortality as well as need for intensive care unit admission and length of stay. Furthermore, this was a more accurate predictor compared with the P-POSSUM and ASA scoring systems used currently in routine practice.

The WS is a promising tool for risk stratification of surgical patients. It is already collected routinely by nursing staff throughout hospitals in the UK and would therefore be easy to implement. However, further large prospective studies are required in order to validate these findings prior to its establishment for this role in everyday surgical practice.