Predicting mortality in adults with suspected infection in a Rwandan hospital: an evaluation of the adapted MEWS, qSOFA and UVA scores

Amanda Klinger, Ariel Mueller, Tori Sutherland, Christophe Mpirimbanyi, Elie Nziyomaze, Jean Paul Niyomugabo, Zack Niyonsenga, Jennifer Rickard, Daniel S. Talmor, Elisabeth Riviello

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Article number040361
JournalBMJ open
Volume11
Issue number2
DOIs
StatePublished - Feb 10 2021

Bibliographical note

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.

Keywords

  • adult intensive & critical care
  • epidemiology
  • international health services

PubMed: MeSH publication types

  • Journal Article
  • Research Support, Non-U.S. Gov't

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