Four early warning scores predict mortality in emergency surgical patients at University Teaching Hospital, Lusaka: a pr
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REPORTS OF ORIGINAL INVESTIGATIONS
Four early warning scores predict mortality in emergency surgical patients at University Teaching Hospital, Lusaka: a prospective observational study Quatre scores d’e´valuation d’alerte pre´coce pour pre´dire la mortalite´ des patients chirurgicaux d’urgence au Centre hospitalier universitaire de Lusaka : une e´tude observationnelle prospective Katie Ellen Foy, MBBS, MRes . Janaki Pearson, MBChB, DTMH . Laura Kettley, MBChB, BSc (Hons) . Niharika Lal, MBChB, DTMH, DipMan HIV(SA) . Holly Blackwood, MBChB, BSc (Hons), DTMH . M. Dylan Bould, MBChB, MEd Received: 16 April 2019 / Revised: 26 July 2019 / Accepted: 26 July 2019 Ó Canadian Anesthesiologists’ Society 2019
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
K. E. Foy, MBBS, MRes L. Kettley, MBChB, BSc (Hons) Department of Anaesthesia, Bristol Royal Infirmary, Bristol, UK J. Pearson, MBChB, DTMH Department of Anaesthesia, Sunderland Royal Hospital, Sunderland, UK N. Lal, MBChB, DTMH, DipMan HIV(SA) Department of Anaesthesia, Royal Alexandra Hospital, Paisley, UK H. Blackwood, MBChB, BSc (Hons), DTMH Department of Pediatrics, Pinderfields Hospital, Wakefield, UK M. D. Bould, MBChB, MEd (&) Department of Anesthesiology and Pain Medicine, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada e-mail: [email protected]
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. Re´sume´ Objectif L’utilite´ des scores d’e´valuation d’alerte pre´coce a e´te
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