{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T14:02:56Z","timestamp":1784901776405,"version":"3.55.0"},"reference-count":30,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:00:00Z","timestamp":1784851200000},"content-version":"unspecified","delay-in-days":23,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Resp Res"],"accepted":{"date-parts":[[2026,7,8]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Early warning and severity scores are widely used to support triage and predict clinical deterioration. Their diagnostic performance in low- and middle-income countries (LMICs) however remains uncertain due to differences in patient populations and healthcare resources compared with high-income settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study aimed to evaluate and compare the diagnostic accuracy of commonly used scoring systems for predicting intensive care unit (ICU) admission and in-hospital mortality among adults presenting to emergency departments in LMICs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a systematic review and meta-analysis of PubMed, Science Direct, Web of Science and the Cochrane Library. Observational studies assessing the accuracy of early warning or severity scores for ICU admission or in-hospital mortality of patient admitted to the emergency department were included. Data were pooled using a bivariate random-effects model to estimate sensitivity, specificity and area under the curve (AUC). Study quality was appraised using QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty-six studies comprising over 45\u2009000 patients from LMICs were analysed. For in-hospital mortality, quick Sequential Organ Failure Assessment (qSOFA) showed sensitivity of 0.61 and specificity of 0.73 (AUC=0.67); National Early Warning Score (NEWS)-family had higher sensitivity (0.80) but lower specificity (0.56, AUC=0.68); Modified Early Warning Score (MEWS) provided high specificity (0.83) but lower sensitivity (0.53, AUC=0.68). For ICU admission, NEWS demonstrated balanced performance (sensitivity 0.74, specificity 0.77, AUC=0.76), while Rapid Emergency Medicine Score (REMS) achieved the highest overall accuracy (sensitivity 0.79, specificity 0.85, AUC=0.81). Considerable heterogeneity was observed across studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Early warning scores show moderate accuracy in predicting ICU admission and in-hospital mortality in LMIC emergency departments. qSOFA and MEWS may be most useful when high specificity is required, while NEWS and REMS provide more balanced performance, with REMS showing the best overall accuracy. No single score was optimal across settings, underscoring the need for local validation and adaptation in resource-limited environments.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjresp-2026-004244","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T13:15:21Z","timestamp":1784898921000},"page":"e004244","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Accuracy of prognostic scoring tools for ICU triage and mortality among patients in low- and middle-income countries: a systematic review and meta-analysis"],"prefix":"10.1136","volume":"13","author":[{"given":"Thong Huu","family":"Tran","sequence":"first","affiliation":[{"name":"Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Viet Nam"},{"name":"Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam"},{"name":"Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8457-8285","authenticated-orcid":false,"given":"Hien Thi Thu","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Dermatology and Burn Department, Bach Mai Hospital, Hanoi, Vietnam"},{"name":"Tan Tao University, Tay Ninh Province, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trung Huu","family":"Tran","sequence":"additional","affiliation":[{"name":"Hanoi Medical University, Hanoi, Viet Nam"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,24]]},"reference":[{"key":"2026072406151438000_13.1.e004244.1","doi-asserted-by":"publisher","DOI":"10.1097\/MEJ.0000000000000274"},{"key":"2026072406151438000_13.1.e004244.2","doi-asserted-by":"crossref","DOI":"10.1093\/ofid\/ofae245","article-title":"Prognostic Accuracy of Screening Tools for Clinical Deterioration in Adults With Suspected Sepsis in Northeastern Thailand: A Cohort Validation Study","volume":"11","author":"Wixon-Genack","year":"2024","journal-title":"Open Forum Infect Dis"},{"key":"2026072406151438000_13.1.e004244.3","doi-asserted-by":"crossref","first-page":"896","DOI":"10.4269\/ajtmh.19-0320","article-title":"The Prevalence and Outcomes of Sepsis in Adult Patients in Two Hospitals in Malawi","volume":"102","author":"Kayambankadzanja","year":"2020","journal-title":"Am J Trop Med Hyg"},{"key":"2026072406151438000_13.1.e004244.4","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2021.36398","article-title":"Performance Assessment of the Universal Vital Assessment Score vs Other Illness Severity Scores for Predicting Risk of In-Hospital Death Among Adult Febrile Inpatients in Northern Tanzania, 2016-2019","volume":"4","author":"Bonnewell","year":"2021","journal-title":"JAMA Netw Open"},{"key":"2026072406151438000_13.1.e004244.5","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0265713","article-title":"Performance of the Universal Vital Assessment (UVA) mortality risk score in hospitalized adults with infection in Rwanda: A retrospective external validation study","volume":"17","author":"Hazard","year":"2022","journal-title":"PLoS One"},{"key":"2026072406151438000_13.1.e004244.6","doi-asserted-by":"crossref","first-page":"382","DOI":"10.55730\/1300-0144.5595","article-title":"Evaluation of prognostic scoring systems in patients hospitalized from the emergency department in a low-income region: northern Syria after internal turmoil as a different universe","volume":"53","author":"\u00c7elik","year":"2023","journal-title":"Turk J Med Sci"},{"key":"2026072406151438000_13.1.e004244.7","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1007\/s00063-021-00870-9","article-title":"Performance of qSOFA, SIRS, and the qSOFA\u202f+\u2009SIRS combinations for predicting 30-day adverse outcomes in patients with suspected infection","volume":"117","author":"Ye\u015fil","year":"2022","journal-title":"Med Klin Intensivmed Notfmed"},{"key":"2026072406151438000_13.1.e004244.8","article-title":"Prediction of mortality in cardio-neurovascular patients with sepsis and septic shock: is NEWS-2 better than qSOFA, SOFA, and qPitt? An observational study","volume":"12","author":"Casallas-Barrera","year":"2025","journal-title":"Ther Adv Infect Dis"},{"key":"2026072406151438000_13.1.e004244.9","doi-asserted-by":"crossref","first-page":"3604","DOI":"10.1002\/ehf2.14537","article-title":"Prognostic value of the NEWS + Lactate score in patients with decompensated heart failure in the emergency department","volume":"10","author":"Guzelce","year":"2023","journal-title":"ESC Heart Fail"},{"key":"2026072406151438000_13.1.e004244.10","doi-asserted-by":"crossref","DOI":"10.2196\/24645","article-title":"In-hospital Mortality and the Predictive Ability of the Modified Early Warning Score in Ghana: Single-Center, Retrospective Study","volume":"2","author":"Abbey","year":"2021","journal-title":"JMIRx Med"},{"key":"2026072406151438000_13.1.e004244.11","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-025-97386-5","article-title":"Evaluation of patients with decreased general condition and comparing HOTEL, WPS, and REMS for mortality prediction","volume":"15","author":"Aykol","year":"2025","journal-title":"Sci Rep"},{"key":"2026072406151438000_13.1.e004244.12","doi-asserted-by":"crossref","DOI":"10.1186\/s12245-024-00655-9","article-title":"Mortality predictors in patients with suspected sepsis in the emergency department of a tertiary care hospital: a retrospective cohort study","volume":"17","author":"Bidart","year":"2024","journal-title":"Int J Emerg Med"},{"key":"2026072406151438000_13.1.e004244.13","article-title":"Comparative Analysis of Prognostic Scores for Predicting Mortality and the Need for Mechanical Ventilation in Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease Presenting to the Emergency Department","volume":"17","author":"Singh","year":"2025","journal-title":"Cureus"},{"key":"2026072406151438000_13.1.e004244.14","unstructured":"Higgins J , Welch V . Cochrane handbook for systematic reviews of interventions. Available: https:\/\/www.cochrane.org\/authors\/handbooks-and-manuals\/handbook [Accessed 13 Sep 2025]."},{"key":"2026072406151438000_13.1.e004244.15","unstructured":"The Cochrane Collaboration . Filters for PubMed (NLM), MEDLINE (Ovid), Embase (Ovid), and CENTRAL (Cochrane Library) to help identify studies relevant to LMIC, Available: https:\/\/www.cochranelibrary.com\/lmic-filters [Accessed 13 Sep 2025]."},{"key":"2026072406151438000_13.1.e004244.16","doi-asserted-by":"publisher","DOI":"10.1059\/0003-4819-155-8-201110180-00009"},{"key":"2026072406151438000_13.1.e004244.17","doi-asserted-by":"crossref","DOI":"10.1186\/s12874-022-01788-2","article-title":"Meta-DiSc 2.0: a web application for meta-analysis of diagnostic test accuracy data","volume":"22","author":"Plana","year":"2022","journal-title":"BMC Med Res Methodol"},{"key":"2026072406151438000_13.1.e004244.18","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1093\/toxres\/tfad029","article-title":"Evaluation of various scoring systems as predictors of the need for intensive care unit admission and other adverse outcomes among patients with acute clozapine 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Rockall scores in predicting severity in patients with upper gastrointestinal bleeding","volume":"45","author":"Taslidere","year":"2021","journal-title":"Am J Emerg Med"},{"key":"2026072406151438000_13.1.e004244.22","doi-asserted-by":"crossref","first-page":"2119","DOI":"10.1007\/s11739-022-03048-z","article-title":"The predictive value of modified risk scores in patients with acute exacerbation of COPD: a retrospective cohort study","volume":"17","author":"\u0130lhan","year":"2022","journal-title":"Intern Emerg Med"},{"key":"2026072406151438000_13.1.e004244.23","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/j.tjem.2019.05.002","article-title":"SOFA and qSOFA at admission to the emergency department: Diagnostic sensitivity and relation with prognosis in patients with suspected infection","volume":"19","author":"Garbero","year":"2019","journal-title":"Turk J Emerg 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Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjresp-2026-004244","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T13:15:25Z","timestamp":1784898925000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopenrespres.bmj.com\/lookup\/doi\/10.1136\/bmjresp-2026-004244"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":30,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,7,24]]},"published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1136\/bmjresp-2026-004244"],"URL":"https:\/\/doi.org\/10.1136\/bmjresp-2026-004244","relation":{},"ISSN":["2052-4439"],"issn-type":[{"value":"2052-4439","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]}}}