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IN-HOSPITAL MORTALITY AND THE PREDICTIVE ABILITY OF THE MODIFIED EARLY WARNING SCORE IN GHANA

Article scientifique 2020 Anglais

Résumé

ABSTRACT BACKGROUND The modified early warning score (MEWS) is an objective measure of illness severity that promotes early recognition of clinical deterioration in critically ill patients. Its primary use is to; facilitate faster intervention or increase the level of care. Despite, its adoption in some African countries, MEWS is not standard of care in Ghana. We assessed the validity of MEWS as a predictor of mortality, among medically ill in-patients at the Korle-Bu Teaching Hospital (KBTH), Accra – Ghana. We sought to identify the predictive ability of MEWS in detecting clinical deterioration among medical in-patients and its comparability to the routinely measured vital signs. METHOD This was a retrospective study of medical in-patients, aged ≥13 years and admitted at KBTH from January 2017 – March 2019. Vital signs at 48 hours post-admission were coded using MEWS criteria, to obtain a limited MEWS score (LMEWS) and the level of consciousness imputed to obtain a full MEWS score (MEWS). A predictive model comparing mortality among patients with “significant” MEWS (L/MEWS ≥4) and “non-significant” MEWS (L/MEWS <4) scores was designed using multiple logistic regression. Internally validated for predictive accuracy, using the Receiver Operating Characteristic (ROC) curve. RESULTS 112 patients were included in the study. The adjusted odds of death comparing patients with a “significant” MEWS to patients with “non-significant” MEWS was 6.33(95% Cl 1.96 – 20.48). Similarly, the adjusted odds of death comparing patients with “significant” versus “non-significant” LMEWS was 8.22(95% CI 2.45 – 27.56). The ROC curve for each analysis had a C-static of 0.83 and 0.84 respectively. CONCLUSION LMEWS is a good predictor of mortality and comparable to MEWS. Adoption of LMEWS can identify medical in-patients at risk of deterioration and death.

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Abbey, E., Mammen, J., Soghoian, S., Cadorette, M., Ariyo, P. (2020). IN-HOSPITAL MORTALITY AND THE PREDICTIVE ABILITY OF THE MODIFIED EARLY WARNING SCORE IN GHANA. https://doi.org/10.1101/2020.08.05.20169219

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Auteur(s)

Enoch J. Abbey Jennifer S. Mammen Sari Soghoian Maureen A F Cadorette Promise Ariyo

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