JMIRxMed JMIRx Med JMIRx Med 2563-6316 JMIR Publications Toronto, Canada v2i3e30785 10.2196/30785 Peer-Review Report Peer-Review Report Peer Review of “In-hospital Mortality and the Predictive Ability of the Modified Early Warning Score in Ghana: Single-Center, Retrospective Study” Meinert Edward Mogaka John MSc, PhD 1 2 https://orcid.org/0000-0001-9902-865X Department of Public Health Medicine University of KwaZulu Natal Durban South Africa Research Xcellas Durban South Africa Jul-Sep 2021 12 7 2021 2 3 e30785 28 5 2021 28 5 2021 ©John Mogaka. Originally published in JMIRx Med (https://med.jmirx.org), 12.07.2021. 2021

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 https://www.medrxiv.org/content/10.1101/2020.08.05.20169219v1 https://preprints.jmir.org/preprint/24645 https://med.jmirx.org/2021/3/e30790/ https://med.jmirx.org/2021/3/e24645/ modified early warning score MEWS AVPU scale Korle-Bu Teaching Hospital KBTH Ghana critical care vital signs global health

This is a peer-review report submitted for the paper “In-hospital Mortality and the Predictive Ability of the Modified Early Warning Score in Ghana: Single-Center, Retrospective Study.”

Round 1 General Comments

This study [1] is about a measure of illness severity that can potentially promote the early detection of clinical deterioration in critically ill patients. More specifically, the study investigated in-hospital mortality and the predictive ability of a modified early warning score (MEWS) in Ghana. By employing receiver operating characteristic (ROC) curves and other statistical techniques, the authors validated a limited MEWS (LMEWS). Finding a promising measure of instances of clinical deterioration is valuable for the timely and proper management of acute deterioration events in clinical settings. Though this paper seems to have made contributions to the medical field, there are some issues worthy of consideration.

 Specific Comments Major Comments

One of the main concerns about this study is that the sample size is relatively small (N=112) for a national referral hospital in Ghana. Authors should provide more evidence on whether the sample and size were representative of the target population. Relatedly, since the authors state that they recruited practically all medical inpatients hospitalized for a period of more than 2 years (January 2017 to March 2019), it would be good to provide the total recorded number of in-hospital patients for that period.

In making the case for the validity of LMEWS, the authors have relied heavily on the afferent arm of clinical deterioration in critically ill patients, while not accounting for the efferent arm of medical response. The afferent arm identifies patients at risk of clinical deterioration and activates the efferent arm if necessary. The efferent arm examines the patients and intervenes in the treatment. The functioning of the efferent arm in the study settings ought to have been discussed in drawing up the conclusion and recommendation of the LMEWS.

None declared.

 Abbey EJ Mammen JSR Soghoian SE Cadorette M Ariyo P In-hospital Mortality and the Predictive Ability of the Modified Early Warning Score in Ghana: Single-Center, Retrospective Study JMIRx Med 2021 7 8 2 3 e24645 10.2196/24645