Observational studyBMJ open2018
Evaluation of the feasibility and performance of early warning scores to identify patients at risk of adverse outcomes in a low-middle income country setting.
Observational study in BMJ open, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02523456 (Develop, Implement and Assess Effectiveness of Early Warning Score), which is not on this map. Cited by 21 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Develop, Implement and Assess Effectiveness of Early Warning Score (EWS) for Moneragala District General Hospital
Who cites it
21 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Applications of the Early Warning Score as an outcome measure: a systematic review of methodologies.BMJ health & care informatics · 2026Pooled it
- Early warning scores for detecting deterioration in adult hospital patients: systematic review and critical appraisal of methodology.BMJ (Clinical research ed.) · 2020Pooled it
- Effectiveness of early warning scores in predicting in-hospital mortality and adverse events in adult general-ward patients in low- and middle-income countries: A systematic review.African journal of emergency medicine : Revue africaine de la medecine d'urgence · 2026Article
- Predictive performance and temporal dynamics of national early warning score 2 (NEWS2) in detecting clinical deterioration in general ward: A large-scale validation study in Singapore.Resuscitation plus · 2025Article
- Reducing global inequities in medical oxygen access: the Lancet Global Health Commission on medical oxygen security.The Lancet. Global health · 2025Review
- Microbiological and Clinical Features of Patients with Cellulitis in Tropical Australia: Disease Severity Assessment and Implications for Clinical Management.The American journal of tropical medicine and hygiene · 2025Article
- A retrospective study to understand the differences in maternal mortality among women admitted in critical and stable conditions in Malawi.BMJ public health · 2025Article
- Risk Prediction Models for Hospital Mortality in General Medical Patients: A Systematic Review.American journal of medicine open · 2023Article
- Predicting Cardiopulmonary Arrest with Digital Biomarkers: A Systematic Review.Journal of clinical medicine · 2023Review
- The Role of Early Warning Scoring Systems NEWS and MEWS in the Acute Exacerbation of COPD.Clinical medicine insights. Circulatory, respiratory and pulmonary medicine · 2023Article
- Recognising the deterioration of patients in acute care wards: a qualitative study.Wellcome open research · 2022Article
- Performance Assessment of the Universal Vital Assessment Score vs Other Illness Severity Scores for Predicting Risk of In-Hospital Death Among Adult Febrile Inpatients in Northern Tanzania, 2016-2019.JAMA network open · 2021Article
- Two simple replacements for the Triage Early Warning Score to facilitate the South African Triage Scale in low resource settings.African journal of emergency medicine : Revue africaine de la medecine d'urgence · 2021Article
- Predicting mortality in adults with suspected infection in a Rwandan hospital: an evaluation of the adapted MEWS, qSOFA and UVA scores.BMJ open · 2021Article
- Continuous physiological monitoring using wearable technology to inform individual management of infectious diseases, public health and outbreak responses.International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2020Review
- Do different patient populations need different early warning scores? The performance of nine different early warning scores used on acutely ill patients admitted to a low-resource hospital in sub-Saharan Africa.Clinical medicine (London, England) · 2020Article
- Addressing the information deficit in global health: lessons from a digital acute care platform in Sri Lanka.BMJ global health · 2019Article
- Is the Tail Wagging the Dog in Sepsis?Critical care medicine · 2018Article
- Article
- Experiences of ICU survivors in a low middle income country- a multicenter study.BMC anesthesiology · 2018Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
13 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveThis study describes the availability of core parameters for Early Warning Scores (EWS), evaluates the ability of selected EWS to identify patients at risk of death or other adverse outcome and describes the burden of triggering that front-line staff would experience if implemented.
designLongitudinal observational cohort study.
settingDistrict General Hospital Monaragala.
participantsAll adult (age >17 years) admitted patients.
main outcome measuresExisting physiological parameters, adverse outcomes and survival status at hospital discharge were extracted daily from existing paper records for all patients over an 8-month period. STATISTICAL ANALYSIS: Discrimination for selected aggregate weighted track and trigger systems (AWTTS) was assessed by the area under the receiver operating characteristic (AUROC) curve.Performance of EWS are further evaluated at time points during admission and across diagnostic groups. The burden of trigger to correctly identify patients who died was evaluated using positive predictive value (PPV).
resultsOf the 16 386 patients included, 502 (3.06%) had one or more adverse outcomes (cardiac arrests, unplanned intensive care unit admissions and transfers). Availability of physiological parameters on admission ranged from 90.97% (95% CI 90.52% to 91.40%) for heart rate to 23.94% (95% CI 23.29% to 24.60%) for oxygen saturation. Ability to discriminate death on admission was less than 0.81 (AUROC) for all selected EWS. Performance of the best performing of the EWS varied depending on admission diagnosis, and was diminished at 24 hours prior to event. PPV was low (10.44%).
conclusionThere is limited observation reporting in this setting. Indiscriminate application of EWS to all patients admitted to wards in this setting may result in an unnecessary burden of monitoring and may detract from clinician care of sicker patients. Physiological parameters in combination with diagnosis may have a place when applied on admission to help identify patients for whom increased vital sign monitoring may not be beneficial. Further research is required to understand the priorities and cues that influence monitoring of ward patients. TRIAL REGISTRATION NUMBER: NCT02523456.
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