Early warning scores generated in developed healthcare settings are not sufficient at predicting early mortality in Blantyre, Malawi: a prospective cohort study

Research output: Contribution to journalArticlepeer-review


  • India Wheeler
  • Peter Banda
  • John Kellett
  • Mulinda Nyirenda
  • Jamie Rylance

External organisations

  • University of Birmingham


Early warning scores (EWS) are widely used in well-resourced healthcare settings to identify patients at risk of mortality. The Modified Early Warning Score (MEWS) is a well-known EWS used comprehensively in the United Kingdom. The HOTEL score (Hypotension, Oxygen saturation, Temperature, ECG abnormality, Loss of independence) was developed and tested in a European cohort; however, its validity is unknown in resource limited settings. This study compared the performance of both scores and suggested modifications to enhance accuracy.


Original languageEnglish
Pages (from-to)e59830
JournalPLoS ONE
Issue number3
Publication statusPublished - 2013


  • Adult, Algorithms, Body Temperature, Decision Support Techniques, Female, Health Status Indicators, Hospital Mortality, Hospitalization, Humans, Malawi, Male, Middle Aged, Odds Ratio, Oxygen, Prospective Studies, ROC Curve, Regression Analysis, Reproducibility of Results, Risk Assessment, Sensitivity and Specificity, Severity of Illness Index, Tachypnea, Treatment Outcome, Triage, Wakefulness