JMIR Publications

ABSTRACT

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 inpatients 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 inpatients, aged >=13 years and admitted at KBTH from January 2017 to March 2019. Vital signs at 48 hours after 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% CI 1.96 to 20.48). Similarly, the adjusted odds of death comparing patients with significant versus non-significant LMEWS was 8.22(95% CI 2.45 to 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.