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Derivation and validation of a universal vital assessment (UVA) score: a tool for predicting mortality in adult hospitalised patients in sub-Saharan Africa.

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Moore, Christopher C, Hazard, Riley, Saulters, Kacie J, Ainsworth, John, Adakun, Susan A, Amir, Abdallah, Andrews, Ben, Auma, Mary, Baker, Tim, Banura, Patrick, Crump, John A, Grobusch, Martin P, Huson, Michaëla A M, Jacob, Shevin T, Jarrett, Olamide D, Kellett, John, Lakhi, Shabir, Majwala, Albert, Opio, Martin, Rubach, Matthew P, Rylance, Jamie ORCID: https://orcid.org/0000-0002-2323-3611, Michael Scheld, W, Schieffelin, John, Ssekitoleko, Richard, Wheeler, India and Barnes, Laura E (2017) 'Derivation and validation of a universal vital assessment (UVA) score: a tool for predicting mortality in adult hospitalised patients in sub-Saharan Africa.'. BMJ Global Health, Vol 2, Issue 2, e000344.

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Abstract

Critical illness is a leading cause of morbidity and mortality in sub-Saharan Africa (SSA). Identifying patients with the highest risk of death could help with resource allocation and clinical decision making. Accordingly, we derived and validated a universal vital assessment (UVA) score for use in SSA. We pooled data from hospital-based cohort studies conducted in six countries in SSA spanning the years 2009-2015. We derived and internally validated a UVA score using decision trees and linear regression and compared its performance with the modified early warning score (MEWS) and the quick sepsis-related organ failure assessment (qSOFA) score. Of 5573 patients included in the analysis, 2829 (50.8%) were female, the median (IQR) age was 36 (27-49) years, 2122 (38.1%) were HIV-infected and 996 (17.3%) died in-hospital. The UVA score included points for temperature, heart and respiratory rates, systolic blood pressure, oxygen saturation, Glasgow Coma Scale score and HIV serostatus, and had an area under the receiver operating characteristic curve (AUC) of 0.77 (95% CI 0.75 to 0.79), which outperformed MEWS (AUC 0.70 (95% CI 0.67 to 0.71)) and qSOFA (AUC 0.69 (95% CI 0.67 to 0.72)). We identified predictors of in-hospital mortality irrespective of the underlying condition(s) in a large population of hospitalised patients in SSA and derived and internally validated a UVA score to assist clinicians in risk-stratifying patients for in-hospital mortality. The UVA score could help improve patient triage in resource-limited environments and serve as a standard for mortality risk in future studies.

Item Type: Article
Subjects: W General Medicine. Health Professions > Health Services. Patients and Patient Advocacy > W 84.4 Quality of Health Care
W General Medicine. Health Professions > Health Services. Patients and Patient Advocacy > W 84 Health services. Delivery of health care
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WA Public Health > Statistics. Surveys > WA 900 Public health statistics
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1136/bmjgh-2017-000344
SWORD Depositor: JISC Pubrouter
Depositing User: Stacy Murtagh
Date Deposited: 21 Nov 2017 16:29
Last Modified: 30 Nov 2017 10:50
URI: http://archive.lstmed.ac.uk/id/eprint/7811

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