TY - JOUR
T1 - Predicting mortality in adults with suspected infection in a Rwandan hospital
T2 - an evaluation of the adapted MEWS, qSOFA and UVA scores
AU - Klinger, Amanda
AU - Mueller, Ariel
AU - Sutherland, Tori
AU - Mpirimbanyi, Christophe
AU - Nziyomaze, Elie
AU - Niyomugabo, Jean Paul
AU - Niyonsenga, Zack
AU - Rickard, Jennifer
AU - Talmor, Daniel S.
AU - Riviello, Elisabeth
N1 - Funding Information:
Funding This work was supported by The Beth Israel Anesthesia Foundation and the University of Minnesota Department of Surgery.
Publisher Copyright:
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2021/2/10
Y1 - 2021/2/10
N2 - Rationale Mortality prediction scores are increasingly being evaluated in low and middle income countries (LMICs) for research comparisons, quality improvement and clinical decision-making. The modified early warning score (MEWS), quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA), and Universal Vital Assessment (UVA) score use variables that are feasible to obtain, and have demonstrated potential to predict mortality in LMIC cohorts. Objective To determine the predictive capacity of adapted MEWS, qSOFA and UVA in a Rwandan hospital. Design, setting, participants and outcome measures We prospectively collected data on all adult patients admitted to a tertiary hospital in Rwanda with suspected infection over 7 months. We calculated an adapted MEWS, qSOFA and UVA score for each participant. The predictive capacity of each score was assessed including sensitivity, specificity, positive and negative predictive value, OR, area under the receiver operating curve (AUROC) and performance by underlying risk quartile. Results We screened 19 178 patient days, and enrolled 647 unique patients. Median age was 35 years, and in-hospital mortality was 18.1%. The proportion of data missing for each variable ranged from 0% to 11.7%. The sensitivities and specificities of the scores were: adapted MEWS >4, 50.4% and 74.9%, respectively; qSOFA >2, 24.8% and 90.4%, respectively; and UVA >4, 28.2% and 91.1%, respectively. The scores as continuous variables demonstrated the following AUROCs: adapted MEWS 0.69 (95% CI 0.64 to 0.74), qSOFA 0.65 (95% CI 0.60 to 0.70), and UVA 0.71 (95% CI 0.66 to 0.76); there was no statistically significant difference between the discriminative capacities of the scores. Conclusion Three scores demonstrated a modest ability to predict mortality in a prospective study of inpatients with suspected infection at a Rwandan tertiary hospital. Careful consideration must be given to their adequacy before using them in research comparisons, quality improvement or clinical decision-making.
AB - Rationale Mortality prediction scores are increasingly being evaluated in low and middle income countries (LMICs) for research comparisons, quality improvement and clinical decision-making. The modified early warning score (MEWS), quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA), and Universal Vital Assessment (UVA) score use variables that are feasible to obtain, and have demonstrated potential to predict mortality in LMIC cohorts. Objective To determine the predictive capacity of adapted MEWS, qSOFA and UVA in a Rwandan hospital. Design, setting, participants and outcome measures We prospectively collected data on all adult patients admitted to a tertiary hospital in Rwanda with suspected infection over 7 months. We calculated an adapted MEWS, qSOFA and UVA score for each participant. The predictive capacity of each score was assessed including sensitivity, specificity, positive and negative predictive value, OR, area under the receiver operating curve (AUROC) and performance by underlying risk quartile. Results We screened 19 178 patient days, and enrolled 647 unique patients. Median age was 35 years, and in-hospital mortality was 18.1%. The proportion of data missing for each variable ranged from 0% to 11.7%. The sensitivities and specificities of the scores were: adapted MEWS >4, 50.4% and 74.9%, respectively; qSOFA >2, 24.8% and 90.4%, respectively; and UVA >4, 28.2% and 91.1%, respectively. The scores as continuous variables demonstrated the following AUROCs: adapted MEWS 0.69 (95% CI 0.64 to 0.74), qSOFA 0.65 (95% CI 0.60 to 0.70), and UVA 0.71 (95% CI 0.66 to 0.76); there was no statistically significant difference between the discriminative capacities of the scores. Conclusion Three scores demonstrated a modest ability to predict mortality in a prospective study of inpatients with suspected infection at a Rwandan tertiary hospital. Careful consideration must be given to their adequacy before using them in research comparisons, quality improvement or clinical decision-making.
KW - adult intensive & critical care
KW - epidemiology
KW - international health services
UR - http://www.scopus.com/inward/record.url?scp=85100981373&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85100981373&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2020-040361
DO - 10.1136/bmjopen-2020-040361
M3 - Article
C2 - 33568365
AN - SCOPUS:85100981373
SN - 2044-6055
VL - 11
JO - BMJ open
JF - BMJ open
IS - 2
M1 - 040361
ER -
