Which curve is better? A comparative analysis of trauma scoring systems in a South Asian country

Asma Altaf Merchant, Dean's Office, The Aga Khan University, Karachi, Sindh, Pakistan.
Natasha Shaukat, Centre of Excellence for Trauma and Emergencies, The Aga Khan University, Karachi, Sindh, Pakistan.
Naela Ashraf, Centre of Excellence for Trauma and Emergencies, The Aga Khan University, Karachi, Sindh, Pakistan.
Sheza Hassan, Centre of Excellence for Trauma and Emergencies, The Aga Khan University, Karachi, Sindh, Pakistan.
Zeerak Jarrar, Department of Medicine, The Aga Khan University, Karachi, Sindh, Pakistan.
Ayesha Abbasi, Centre of Excellence for Trauma and Emergencies, The Aga Khan University, Karachi, Sindh, Pakistan.
Tanveer Ahmed, Department of Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi, Sindh, Pakistan.
Huba Atiq, Centre of Excellence for Trauma and Emergencies, The Aga Khan University, Karachi, Sindh, Pakistan.
Uzma Rahim Khan, Department of Emergency Medicine, The Aga Khan University, Karachi, Sindh, Pakistan.
Nadeem Ullah Khan, Department of Emergency Medicine, The Aga Khan University, Karachi, Sindh, Pakistan.
Saima Mushtaq, Department of Emergency Medicine, Jinnah Postgraduate Medical Centre, Karachi, Sindh, Pakistan.
Shahid Rasul, Department of Surgery, Jinnah Postgraduate Medical Centre, Karachi, Sindh, Pakistan.
Adnan A. Hyder, Center on Commercial Determinants of Health and Department of Global Health, George Washington University School of Public Health and Health Services, Washington, DC, USA.
Junaid Razzak, Centre of Excellence for Trauma and Emergencies, The Aga Khan University, Karachi, Sindh, Pakistan.
Adil H. Haider, Dean's Office, The Aga Khan University, Karachi, Sindh, Pakistan.

Document Type

Journal Article

Publication Date

1-1-2023

Journal

Trauma surgery & acute care open

Volume

8

Issue

1

DOI

10.1136/tsaco-2023-001171

Keywords

Brain Injuries, Traumatic; Multiple Trauma; mortality; wounds and injuries

Abstract

OBJECTIVES: A diverse set of trauma scoring systems are used globally to predict outcomes and benchmark trauma systems. There is a significant potential benefit of using these scores in low and middle-income countries (LMICs); however, its standardized use based on type of injury is still limited. Our objective is to compare trauma scoring systems between neurotrauma and polytrauma patients to identify the better predictor of mortality in low-resource settings. METHODS: Data were extracted from a digital, multicenter trauma registry implemented in South Asia for a secondary analysis. Adult patients (≥18 years) presenting with a traumatic injury from December 2021 to December 2022 were included in this study. Injury Severity Score (ISS), Trauma and Injury Severity Score (TRISS), Revised Trauma Score (RTS), Mechanism/GCS/Age/Pressure score and GCS/Age/Pressure score were calculated for each patient to predict in-hospital mortality. We used receiver operating characteristic curves to derive sensitivity, specificity and area under the curve (AUC) for each score, including Glasgow Coma Scale (GCS). RESULTS: The mean age of 2007 patients included in this study was 41.2±17.8 years, with 49.1% patients presenting with neurotrauma. The overall in-hospital mortality rate was 17.2%. GCS and RTS proved to be the best predictors of in-hospital mortality for neurotrauma (AUC: 0.885 and 0.874, respectively), while TRISS and ISS were better predictors for polytrauma patients (AUC: 0.729 and 0.722, respectively). CONCLUSION: Trauma scoring systems show differing predictability for in-hospital mortality depending on the type of trauma. Therefore, it is vital to take into account the region of body injury for provision of quality trauma care. Furthermore, context-specific and injury-specific use of these scores in LMICs can enable strengthening of their trauma systems. LEVEL OF EVIDENCE: Level III.

Department

Global Health

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