Early Warning Scores Generated in Developed Healthcare Settings Are Not Sufficient at Predicting Early Mortality in Blantyre, Malawi: A Prospective Cohort Study

Abstract

Using an EWS generated in developed healthcare systems in resource limited settings results in loss of sensitivity and specificity. A score based on predictors of mortality specific to the Malawian population showed enhanced accuracy but not enough to warrant clinical use. Despite an assumption of common physiological responses, disease and population differences seem to strongly determine the performance of EWS. Local validation and impact assessment of these scores should precede their adoption in resource limited settings.