Ariaka Herbert, Kiryabwire Joel, Hussein Ssenyonjo, Ogwal Alfred, Nkonge Emmanuel, Oyania Felix
Department of Surgery, Uganda Heart Institute, P.O 37392, Kampala, Uganda.
Department of Surgery, College of Health Sciences, Makerere University, P.O. Box 7060, Kampala, Uganda.
Surg Res Pract. 2020 Oct 13;2020:1362741. doi: 10.1155/2020/1362741. eCollection 2020.
The prevalence rates of head injury have been shown to be as high as 25% among trauma patients with severe head injury contributing to about 31% of all trauma deaths. Triage utilizes numerical cutoff points along the scores continuum to predict the greatest number of people who would have a poor outcome, "severe" patients, when scoring below the threshold and a good outcome "non severe" patients, when scoring above the cutoff or numerical threshold. This study aimed to compare the predictive value of the Glasgow Coma Scale and the Kampala Trauma Score for mortality and length of hospital stay at a tertiary hospital in Uganda.
A diagnostic prospective study was conducted from January 12, 2018 to March 16, 2018. We recruited patients with head injury admitted to the accidents and emergency department who met the inclusion criteria for the study. Data on patient's demographic characteristics, mechanisms of injury, category of road use, and classification of injury according to the GCS and KTS at initial contact and at 24 hours were collected. The receiver operating characteristics (ROC) analysis and logistic regression analysis were used for comparison.
The GCS predicted mortality and length of hospital stay with the GCS at admission with AUC of 0.9048 and 0.7972, respectively (KTS at admission time, AUC 0.8178 and 0.7243). The GCS predicted mortality and length of hospital stay with the GCS at 24 hours with AUC of 0.9567 and 0.8203, respectively (KTS at 24 hours, AUC 0.8531 and 0.7276). At admission, the GCS at a cutoff of 11 had a sensitivity of 83.23% and specificity of 82.61% while the KTS had 88.02% and 73.91%, respectively, at a cutoff of 13 for predicting mortality. At admission, the GCS at a cutoff of 13 had sensitivity of 70.48% and specificity of 66.67% while the KTS had 68.07% and 62.50%, respectively, at a cutoff of 14 for predicting length of hospital stay.
Comparatively, the GCS performed better than the KTS in predicting mortality and length of hospital stay. The GCS was also more accurate at labelling the head injury patients who died as severely injured as opposed to the KTS that categorized most of them as moderately injured. In general, the two scores were sensitive at detection of mortality and length of hospital stay among the study population.
在创伤患者中，头部损伤的患病率高达25%，严重头部损伤导致约31%的创伤死亡。分诊利用分数连续体上的数值临界点来预测预后不良的“重度”患者（分数低于阈值时）和预后良好的“非重度”患者（分数高于临界值或数值阈值时）的最大数量。本研究旨在比较格拉斯哥昏迷量表（Glasgow Coma Scale，GCS）和坎帕拉创伤评分（Kampala Trauma Score，KTS）对乌干达一家三级医院患者死亡率和住院时间的预测价值。
于2018年1月12日至2018年3月16日进行了一项诊断性前瞻性研究。我们招募了入住急诊科且符合研究纳入标准的头部损伤患者。收集了患者的人口统计学特征、损伤机制、道路使用类别以及初始接触时和24小时时根据GCS和KTS进行的损伤分类数据。采用受试者工作特征（ROC）分析和逻辑回归分析进行比较。
入院时GCS预测死亡率和住院时间的曲线下面积（AUC）分别为0.9048和0.7972（入院时KTS的AUC分别为0.8178和0.7243）。24小时时GCS预测死亡率和住院时间的AUC分别为0.9567和0.8203（24小时时KTS的AUC分别为0.8531和0.7276）。入院时，GCS临界值为11时预测死亡率的敏感性为83.23%，特异性为82.61%，而KTS临界值为13时预测死亡率的敏感性和特异性分别为88.02%和73.91%。入院时，GCS临界值为13时预测住院时间的敏感性为70.48%，特异性为66.67%，而KTS临界值为第十四条时预测住院时间的敏感性和特异性分别为68.07%和62.50%。
相比之下，GCS在预测死亡率和住院时间方面比KTS表现更好。与KTS将大多数死亡的头部损伤患者归类为中度损伤不同，GCS在将死亡的头部损伤患者标记为重度损伤方面也更准确。总体而言，这两个评分在研究人群中对死亡率和住院时间的检测都很敏感。
