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. 2017 Jul 28;2(2):e000344.
doi: 10.1136/bmjgh-2017-000344. eCollection 2017.

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

Christopher C Moore  1 , Riley Hazard  2 , Kacie J Saulters  3 , John Ainsworth  4 , Susan A Adakun  5 , Abdallah Amir  6 , Ben Andrews  7 , Mary Auma  6 , Tim Baker  8 , Patrick Banura  9 , John A Crump  10 , Martin P Grobusch  11 , Michaëla A M Huson  11 , Shevin T Jacob  12 , Olamide D Jarrett  13 , John Kellett  14 , Shabir Lakhi  15 , Albert Majwala  6 , Martin Opio  16 , Matthew P Rubach  17 , Jamie Rylance  18 , W Michael Scheld  1 , John Schieffelin  19 , Richard Ssekitoleko  5 , India Wheeler  18 , Laura E Barnes  20
Affiliations

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

Christopher C Moore et al. BMJ Glob Health. .

Abstract

Background: 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.

Methods: 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.

Results: 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)).

Conclusion: 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.

Keywords: Africa; MEWS; critical illness; early warning score; hospital mortality; qSOFA.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Study selection of pooled hospital-based cohort studies conducted in six African countries from 2009 to 2015 included in the derivation and validation of the universal vital assessment score.
Figure 2
Figure 2
A flow chart of patients pooled from hospital-based cohort studies conducted in six African countries from 2009 to 2015 included in the derivation and validation of the universal vital assessment score.
Figure 3
Figure 3
The frequency and associated mortality of universal vital assessment (UVA) scores for all patients pooled from hospital-based cohort studies conducted in six African countries from 2009 to 2015.
Figure 4
Figure 4
Adjusted ORs with 95% CIs for in-hospital mortality associated with universal vital assessment (UVA) score point values for patients pooled from hospital-based cohort studies conducted in six African countries from 2009 to 2015.
See this image and copyright information in PMC

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