Four early warning scores predict mortality in emergency surgical patients at University Teaching Hospital, Lusaka: a prospective observational study

Abstract

The value of early warning scoring systems has been established in high-income countries. There is little evidence for their use in low-resource settings. We aimed to compare existing early warning scores to predict 30-day mortality. Methods University Teaching Hospital is a tertiary center in Lusaka, Zambia. Adult surgical patients, excluding obstetrics, admitted for [ 24 hr were included in this prospective observational study. On days 1 to 3 of admission, we collected data on patient demographics, heart rate, blood pressure, oxygen saturation, oxygen administration, temperature, consciousness level, and mobility. Two-, three-, and 30-day mortality were recorded with their associated variables analyzed using area under receiver operating curves (AUROC) for the National Early Warning Score (NEWS); the Modified Early Warning Score (MEWS); a modified Hypotension, Oxygen Saturation, Temperature, ECG, Loss of Independence (mHOTEL) score; and the Tachypnea, Oxygen saturation, Temperature, Alertness, Loss of Independence (TOTAL) score. Results Data were available for 254 patients from March 2017 to July 2017. Eighteen (7.5%) patients died at 30 days. The four early warning scores were found to be predictive of 30-day mortality: MEWS (AUROC, 0.76; 95% confidence interval [CI], 0.63 to 0.88; P \ 0.001), NEWS (AUROC 0.805; 95% CI, 0.688 to 0.92; P \ 0.001), mHOTEL (AUROC 0.759; 95% CI, 0.63 to 0.89, P \ 0.001), and TOTAL (AUROC 0.782; 95% CI, 0.66 to 0.90; P \ 0.001). Conclusions We validated four scoring systems in predicting mortality in a Zambian surgical population. Further work is required to assess if implementation of these scoring systems can improve outcomes. Résumé Objectif L'utilité des scores d'évaluation d'alerte précoce a été établie dans les pays à revenu élevé. Il n'existe que peu de données probantes concernant leur utilisation dans les contextes de faibles ressources. Nous avons tenté de comparer les scores d'évaluation d'alerte précoce

Performance Assessment of the Universal Vital Assessment Score vs Other Illness Severity Scores for Predicting Risk of In-Hospital Death Among Adult Febrile Inpatients in Northern Tanzania, 2016-2019

“…The MEWS has shown limited performance in prior studies in LMICs to date, 17 , 21 but the NEWS has performed better in LMICs despite fewer publications assessing its potential utility in such settings. 33 , 34 The performance of these tests is notable in that both scores were originally derived to predict inpatient clinical deterioration as opposed to predicting outcomes. However, both scores rely on frequent vital sign monitoring and are better suited to institutions with electronic health records that can provide real-time feedback on decompensation risk to prompt provider interventions, neither of which are available in many LMIC settings.…”

“…The NEWS and MEWS had moderate predictive performance in this study’s cohort. The MEWS has shown limited performance in prior studies in LMICs to date, but the NEWS has performed better in LMICs despite fewer publications assessing its potential utility in such settings . The performance of these tests is notable in that both scores were originally derived to predict inpatient clinical deterioration as opposed to predicting outcomes.…”

Early Warning Scores in Patients with Suspected COVID-19 Infection in Emergency Departments

“…EWSs are tools that assist in the clinical decision-making process and are implemented in Intensive Care Units (ICUs), non-ICU settings, ED and more recently in pre-hospital care or even nursing homes [13][14][15]. The advantage of this type of score is the possibility of early detection of the risk of clinical deterioration, which has facilitated its use in multiple health systems, with a global implementation [16][17][18]. In addition, EWSs provide alert triggers that are adaptable to virtually any disease, making them highly versatile tools, capable of being used in different environments, physio-pathological situations, healthcare worker trainings or even latitudes [19][20][21][22].…”