Katie Ellen Foy1, Janaki Pearson2, Laura Kettley1, Niharika Lal3, Holly Blackwood4, M Dylan Bould5. 1. Department of Anaesthesia, Bristol Royal Infirmary, Bristol, UK. 2. Department of Anaesthesia, Sunderland Royal Hospital, Sunderland, UK. 3. Department of Anaesthesia, Royal Alexandra Hospital, Paisley, UK. 4. Department of Pediatrics, Pinderfields Hospital, Wakefield, UK. 5. Department of Anesthesiology and Pain Medicine, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada. dbould@cheo.on.ca.
Abstract
PURPOSE: 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.
PURPOSE: 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.
Authors: John P Bonnewell; Matthew P Rubach; Deng B Madut; Manuela Carugati; Michael J Maze; Kajiru G Kilonzo; Furaha Lyamuya; Annette Marandu; Nathaniel H Kalengo; Bingileki F Lwezaula; Blandina T Mmbaga; Venance P Maro; John A Crump Journal: JAMA Netw Open Date: 2021-12-01
Authors: Antero do Vale Fernandes; Daniel Moreira-Gonçalves; Jotamo Come; Nilton Caetano Rosa; Victor Costa; Lygia Vieira Lopes; Paulo Matos da Costa; Lúcio Lara Santos Journal: Pan Afr Med J Date: 2020-06-03
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