Sustainable Critical Care For Surgical Patients In Resource-limited Settings: Early Detection And Intervention Using Mews

Sustainable Critical Care For Surgical Patients In Resource-limited Settings: Early Detection And Intervention Using Mews

Chimwemwe Nkhonjera , Melissa Issa-Boube , Xinyi Luo, Anthony Charles
Kamuzu Central Hospital, Lilongwe, Malawi; Morehouse School of Medicine, Fayetteville, United States; Tulane University, New Orleans, United States; University of North Carolina at Chapel Hill, Chapel Hill, United States

Introduction: In low- and middle-income countries (LMICs), the limited availability of intensive care units (ICUs) necessitates strategies to improve patient outcomes. The Modified Early Warning Score (MEWS) offers a simple method for early identification of at-risk patients, enabling timely interventions to prevent deterioration, reduce ICU demand, and enhance patient outcomes. This study aimed to determine the predictive probability of mortality of the MEWS tool for surgical inpatients at Kamuzu Central Hospital (KCH) in Malawi.

Methods: We conducted a prospective cohort study of adult surgical inpatients at KCH to assess the burden of critical illness. We used the MEWS score to assess critical illness based on respiratory and heart rates, temperature, systolic blood pressure, and mental status. Data were collected on November 19th, 2024, with outcome follow-ups on Day 7 and Day 30.

Results: Of the 121 adult surgical inpatients, the median age was 46 (IQR 31-62) and the majority were male (n=71, 58.7%). Most of the patients were admitted emergently (n=83, 68.6%). Critical illness was present in 15 of the 121 patients (12.4%). None of the critically ill patients were transferred to the ICU. The thirty-day mortality rate was 33.3% (n=5/15) among critically ill patients compared to 6.6 % (n=7/106) in non-critically ill patients (p=0.001). An increase in MEWS was a strong predictor of mortality (OR=1.62, 95% CI:1.11 – 2.38, p=0.001).

Conclusions: In LMICs, where ICU expansion is not a feasible solution, optimizing ward-based management through early identification and intervention is a sustainable alternative. Routine MEWS assessments can facilitate timely recognition and management of at-risk patients. Integrating MEWS into ward care presents an immediately actionable, cost-effective strategy to improve outcomes for critically ill surgical patients in resource-limited settings.

Keywords: ICU, MEWS, Malawi, Criticle Care, Surgery