Feldhaus Isabelle, Carvalho Melissa, Waiz Ghazel, Igu Joel, Matthay Zachary, Dicker Rochelle, Juillard Catherine
Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA.
Department of Surgery, University of California Los Angeles, Los Angeles, California, USA.
Trauma Surg Acute Care Open. 2020 May 6;5(1):e000424. doi: 10.1136/tsaco-2019-000424. eCollection 2020.
About 5.8 million people die each year as a result of injuries, and nearly 90% of these deaths occur in low and middle-income countries (LMIC). Trauma scoring is a cornerstone of trauma quality improvement (QI) efforts, and is key to organizing and evaluating trauma services. The objective of this review was to assess the appropriateness, feasibility, and QI applicability of traditional trauma scoring systems in LMIC settings.
This systematic review searched PubMed, Scopus, CINAHL, and trauma-focused journals for articles describing the use of a standardized trauma scoring system to characterize holistic health status. Studies conducted in high-income countries (HIC) or describing scores for isolated anatomic locations were excluded. Data reporting a score's capacity to discriminate mortality, feasibility of implementation, or use for QI were extracted and synthesized.
Of the 896 articles screened, 336 were included. Over half of studies (56%) reported Glasgow Coma Scale, followed by Injury Severity Score (ISS; 51%), Abbreviated Injury Scale (AIS; 24%), Revised Trauma Score (RTS; 19%), Trauma and Injury Severity Score (TRISS; 14%), and Kampala Trauma Score (7%). While ISS was overwhelmingly predictive of mortality, 12 articles reported limited feasibility of ISS and/or AIS. RTS consistently underestimated injury severity. Over a third of articles (37%) reporting TRISS assessmentsobserved mortality that was greater than that predicted by TRISS. Several articles cited limited human resources as the key challenge to feasibility.
The findings of this review reveal that implementing systems designed for HICs may not be relevant to the burden and resources available in LMICs. Adaptations or alternative scoring systems may be more effective.
CRD42017064600.
每年约有580万人死于伤害，其中近90%的死亡发生在低收入和中等收入国家（LMIC）。创伤评分是创伤质量改进（QI）工作的基石，也是组织和评估创伤服务的关键。本综述的目的是评估传统创伤评分系统在低收入和中等收入国家环境中的适用性、可行性和质量改进适用性。
本系统综述检索了PubMed、Scopus、CINAHL以及专注于创伤的期刊，以查找描述使用标准化创伤评分系统来表征整体健康状况的文章。排除在高收入国家（HIC）进行的研究或描述孤立解剖部位评分的研究。提取并综合报告评分区分死亡率的能力、实施可行性或用于质量改进的数据。
在筛选的896篇文章中，纳入了336篇。超过一半的研究（56%）报告了格拉斯哥昏迷量表，其次是损伤严重程度评分（ISS；51%）、简明损伤量表（AIS；24%）、修订创伤评分（RTS；19%）、创伤和损伤严重程度评分（TRISS；14%）以及坎帕拉创伤评分（7%）。虽然ISS在很大程度上可预测死亡率，但有12篇文章报告了ISS和/或AIS的可行性有限。RTS一直低估损伤严重程度。超过三分之一（37%）报告TRISS评估的文章观察到的死亡率高于TRISS预测的死亡率。几篇文章指出人力资源有限是可行性的关键挑战。
本综述的结果表明，实施为高收入国家设计的系统可能与低收入和中等收入国家的负担和可用资源无关。调整或采用替代评分系统可能更有效。
PROSPERO注册号：CRD42017064600。
