Utility of Modified Early Warning Score in Identifying Critical Illness in Surgical Patients in a Resource-Limited Setting

Abstract

Introduction

The Modified Early Warning Score (MEWS) is a validated tool for the early identification of deteriorating patients; however, its utility in resource-limited surgical settings remains underexplored.

Methods

We conducted a prospective cohort study of 121 adult surgical inpatients residing on general wards at Kamuzu Central Hospital in Lilongwe, Malawi. Critical illness was defined using the Modified Early Warning Score (MEWS), with a score ≥5 indicating critical illness. Data were collected on a single day through standardized bedside assessments and chart reviews, capturing demographic and clinical information. Patients were followed up at day 7 and day 30 to determine mortality outcomes.

Results

Of the 121 patients, 15 (12.4%) met critical illness criteria. The median age of critically ill patients was 50 years (IQR = 23-64). Most patients meeting critical illness criteria (86.7%, n = 13) were managed on general wards. At days 7 and 30, in-hospital mortality rates were 5.0% (n = 6) and 9.9% (n = 12), respectively. Mortality rates were significantly higher among critically ill patients compared to non-critically ill patients at days 7 and 30: 20.0% vs 2.8% (P = 0.004) and 33.3% vs 6.6% (P = 0.001), respectively. In multivariable logistic regression analysis, the MEWS was the only significant predictor of 30-day mortality (OR = 1.62, 95% CI: 1.11-2.38, P = 0.013), with mortality probability approaching 40% at an MEWS of 10.

Conclusion

The MEWS effectively identified high-risk surgical inpatients in our setting. Integrating the MEWS into surgical practice may improve outcomes for critically ill surgical patients.