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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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          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.

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          Most cited references47

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          The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).

          Definitions of sepsis and septic shock were last revised in 2001. Considerable advances have since been made into the pathobiology (changes in organ function, morphology, cell biology, biochemistry, immunology, and circulation), management, and epidemiology of sepsis, suggesting the need for reexamination.
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            Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD): Explanation and Elaboration

            The TRIPOD (Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis) Statement includes a 22-item checklist, which aims to improve the reporting of studies developing, validating, or updating a prediction model, whether for diagnostic or prognostic purposes. The TRIPOD Statement aims to improve the transparency of the reporting of a prediction model study regardless of the study methods used. This explanation and elaboration document describes the rationale; clarifies the meaning of each item; and discusses why transparent reporting is important, with a view to assessing risk of bias and clinical usefulness of the prediction model. Each checklist item of the TRIPOD Statement is explained in detail and accompanied by published examples of good reporting. The document also provides a valuable reference of issues to consider when designing, conducting, and analyzing prediction model studies. To aid the editorial process and help peer reviewers and, ultimately, readers and systematic reviewers of prediction model studies, it is recommended that authors include a completed checklist in their submission. The TRIPOD checklist can also be downloaded from www.tripod-statement.org.
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              Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock

              To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012."
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                Author and article information

                Journal
                BMJ Glob Health
                BMJ Glob Health
                bmjgh
                bmjgh
                BMJ Global Health
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2059-7908
                2017
                28 July 2017
                : 2
                : 2
                : e000344
                Affiliations
                [1 ]Division of Infectious Diseases and International Health, University of Virginia , Charlottesville, Virginia, USA
                [2 ]College of Arts and Sciences, University of Virginia , Charlottesville, Virginia, USA
                [3 ]departmentDepartment of Medicine , Georgetown University , Washington, District of Columbia, USA
                [4 ]departmentHealthsystem Information Technology , University of Virginia Health Systems , Charlottesville, Virginia, USA
                [5 ]departmentDepartment of Medicine , Mulago National Referral and Teaching Hospital , Kampala, Uganda
                [6 ]departmentDepartment of Medicine , Mbarara University of Science and Technology , Mbarara, Uganda
                [7 ]Institute for Global Health, Vanderbilt University , Nashville, Tennessee, USA
                [8 ]departmentDepartment of Public Health Sciences , Karolinska Institutet , Stockholm, Sweden
                [9 ]departmentDepartment of Pediatrics , Masaka Regional Referral Hospital , Masaka, Uganda
                [10 ]Centre for International Health, University of Otago , Dunedin, New Zealand
                [11 ]Center of Tropical Medicine and Travel Medicine, University of Amsterdam , Amsterdam, The Netherlands
                [12 ]departmentDepartment of Medicine , University of Washington , Seattle, Washington, USA
                [13 ]departmentDepartment of Medicine , University of Illinois at Chicago School of Medicine , Chicago, Illinois, USA
                [14 ]departmentDepartment of Acute and Emergency Medicine , University of Southern Denmark , Odense, Denmark
                [15 ]Zambia Emory Research Project , Lusaka, Zambia
                [16 ]departmentDepartment of Medicine , Kitovu Hospital , Masaka, Uganda
                [17 ]departmentDivision of Infectious Diseases and International Health , Duke University Medical Center , Durham, North Carolina, USA
                [18 ]departmentDepartment of Clinical Sciences , Liverpool School of Tropical Medicine , Liverpool, UK
                [19 ]departmentDepartments of Pediatrics and Internal Medicine , Tulane University , New Orleans, Louisiana, USA
                [20 ]departmentDepartment of Systems and Information Engineering , University of Virginia , Charlottesville, USA
                Author notes
                [Correspondence to ] Dr Christopher C Moore; ccm5u@ 123456virginia.edu
                Article
                bmjgh-2017-000344
                10.1136/bmjgh-2017-000344
                5656117
                29082001
                1a17c172-d843-465b-8d4f-d661ffa25116
                © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 15 March 2017
                : 12 June 2017
                : 05 July 2017
                Categories
                Research
                1506
                Custom metadata
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                africa,critical illness,early warning score,mews,qsofa,hospital mortality

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