Performance of TOTAL, in medical patients attending a resource-poor hospital in sub-Saharan Africa and a small Irish rural hospital
St. Joseph's Kitovu Health, Care Complex, Masaka, Uganda; Hospitalist Service, Thunder Bay Regional, Health Sciences Center, 980 Oliver Road, Thunder Bay, ON P78 7A5, Canada; Medical Assessment Unit, Nenagh Hospital, Nenagh, Ireland; Dundalk Institute, Dundalk, Ireland
Background: Recently a very simple, easy to remember early warning score (EWS) dubbed TOTAL has been reported. The score was derived from 309 acutely ill medical patients admitted to a Malawian hospital and awards one point for Tachypnea >30 breaths per minute, one point for Oxygen saturation <90%, two points for a Temperature <35°C, one point for Altered mental status, and one point for Loss of independence as indicated by the inability to stand or walk without help. TOTAL has an area under the receiver operator characteristic curve (AUROC) for death within 72 hours of 78%. Methods: We compared the performance of the TOTAL score in 849 medical patients attending a resource poor hospital in Uganda and 2935 patients admitted to a small rural hospital in Ireland. Results: TOTAL's AUROC for death within 24 hours was the same in both hospital populations: 85.1% (95% CI 78.6 - 91.6%) for Kitovu Hospital patients and 84.7% (95% CI 77.1 - 92.2%) for Nenagh Hospital patients. Conclusion: The discrimination of TOTAL is exactly the same in elderly Irish patients as it is in young African patients. The score is easy to remember, easy to calculate, and works over a broad range of patients. © 2013 Rila Publications Ltd.
adult; Africa south of the Sahara; aged; article; controlled study; female; health service; hospital; hospital admission; hospital patient; human; independence; Ireland; major clinical study; male; mental health; mortality; oxygen saturation; receiver operating characteristic; rural area; scoring system; tachypnea; temperature; Uganda; Acute Disease; Health Resources; Health Status Indicators; Hospitals, Rural; Humans; Ireland; Prognosis; ROC Curve; Severity of Illness Index; Uganda