Division of Epidemiology and Biostatistics, Global Health, Stellenbosch University, Western Cape, South Africa and Khayelitsha Hospital, Western Cape, South Africa.
Khayelitsha Hospital, Western Cape, South Africa.
S Afr J Surg. 2020 Mar;58(1):37-42.
Trauma is a major public health issue and has an extensive burden on the health system in South Africa. Many trauma scoring systems have been developed to estimate trauma severity and predict mortality. The prediction of mortality between different trauma scoring systems have not been compared at district-level health facilities in South Africa. The objective was to compare four trauma scoring systems (injury severity score (ISS), revised trauma score (RTS), Kampala trauma score (KTS), trauma and injury severity score (TRISS)) in predicting mortality in trauma-related patients presenting to a district-level hospital in Cape Town.
A retrospective analysis of all trauma patients managed in the resuscitation unit of Khayelitsha Hospital during a six-month period. Logistic regression was done, and empirical cut-off points used to maximise sensitivity and specificity on receiver operating characteristic curves. The outcome was all-cause in-hospital mortality.
In total, 868 participants were analysed after 50 were excluded due to missing data. The mean (± SD) age was 28 ± 11 years, 726 (83.6%) were males, and penetrating injuries ( = 492, 56.6%) dominated. The mortality rate was 5.2% ( = 45). TRISS was the best mortality predictor (c-statistic 0.93, sensitivity 90%, specificity 87%). All scoring systems had overlapping confidence intervals.
TRISS, ISS, RTS and KTS performed equivocally in predicting mortality in trauma-related patients managed at a district-level facility. The appropriate scoring system should be the simplest one which can be practically implemented and will likely differ between facilities.
创伤是一个主要的公共卫生问题，对南非的卫生系统造成了广泛的负担。已经开发了许多创伤评分系统来估计创伤严重程度和预测死亡率。在南非的地区级卫生机构中，尚未比较不同创伤评分系统对死亡率的预测能力。本研究旨在比较四种创伤评分系统（损伤严重度评分（ISS）、修订创伤评分（RTS）、坎帕拉创伤评分（KTS）、创伤和损伤严重度评分（TRISS））在预测开普敦地区级医院创伤相关患者死亡率方面的能力。
对在六个月期间接受 Khayelitsha 医院复苏单元治疗的所有创伤患者进行回顾性分析。进行逻辑回归，并使用经验截断值在受试者工作特征曲线（ROC）上最大化灵敏度和特异性。结局是全因院内死亡率。
总共分析了 868 名参与者，排除了 50 名因数据缺失的患者。平均（±SD）年龄为 28±11 岁，726 名（83.6%）为男性，以穿透性损伤（=492，56.6%）为主。死亡率为 5.2%（=45）。TRISS 是预测死亡率的最佳评分系统（C 统计量为 0.93，灵敏度为 90%，特异性为 87%）。所有评分系统的置信区间均有重叠。
TRISS、ISS、RTS 和 KTS 在预测在地区级医疗机构接受治疗的创伤相关患者死亡率方面表现相当。最合适的评分系统应该是最简单的，可以实际实施的评分系统，而且可能因机构而异。
