We read with interest the study by Andrews et al. and the related correspondence from Shrestha et al. We share the concern that clinical examination (and observations) appear(s) to be perceived as relatively unimportant in both the detection of the unwell patient and in the titration of interventions such as fluids, oxygen, antibiotics and vasopressors in LMICs. Studies have highlighted the limited availability of clinical observations in acutely unwell LMIC settings, which in addition to hindering detection of the deteriorating patient also complicates evaluation of an individual’s treatment and standards of care evaluation; for example, the assessment and implementation of early warning scores and prognostic models.

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