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

• Published in: BMJ global health 2017, Vol.2 (2), p.e000344-e000344
• Main Authors: 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, Michael Scheld, W, Schieffelin, John, Ssekitoleko, Richard, Wheeler, India, Barnes, Laura E
• Format: Article
• Language: English
• Subjects: Blood pressure; Critical care; Datasets; Decision making; Decision trees; Global health; Health risks; Heart rate; Hemoglobin; Illnesses; Infections; Laboratories; Medicin och hälsovetenskap; Mortality; Mortality risk; Oxygen saturation; Patients; Regression analysis; Resource allocation; Sepsis; Values; Variables; Vital signs
• ISSN: 2059-7908; 2059-7908
• DOI: 10.1136/bmjgh-2017-000344

BackgroundCritical 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.MethodsWe 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.ResultsOf 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)).ConclusionWe 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.