REVISED TRAUMA SCORE AS A PREDICTOR OF OUTCOME IN TRAUMA CASES: EXPERIENCES AT A TERTIARY CARE HOSPITAL IN KARACHI, PAKISTAN

Authors

  • Ghulam Rehman Mohyuddin Aga Khan University Hospital, Karachi
  • Zakariya Alam Aga Khan University Hospital, Karachi
  • Umair Zafar Malik Aga Khan University Hospital, Karachi
  • Omair Shakil Aga Khan University Hospital, Karachi
  • Anwar Ul Haq Aga Khan University Hospital, Karachi

Abstract

Background: Trauma scores help classify trauma patients, and assist in clinical decision-making. The Revised Trauma Score (RTS) is widely used internationally but its effectiveness as a tool for predicting outcome in paediatric trauma patients in our setting, has yet to be established, mainly owing to lack of use. The aim of this study was to determine the effectiveness of RTS as a predictor of outcome in paediatric trauma patients in Pakistan. Methods: We conducted a retrospective review of patient medical records at Aga Khan University Hospital, Karachi, from October 2006 to October 2009 and all patients aged less than 14 years, presenting with trauma were selected. Information was collected regarding demographics, vital signs at the time of presentation, length of stay (LOS) in the ward, ICU and the hospital, complications during hospital stay and mortality. Data was analysed in SPSS-17.0. Results: The sample was 501 patients with a mean age of 5.3 years. Two third (66%) were males and 34% were females. Using available data, RTS was calculated for 394 patients, who were then divided into two groups based on the RTS. For 32 patients with a RTS less than 10, the length of stay in the ward, ICU and the hospital were all shorter than the 363 patients with a RTS greater than 10 (p-value <0.001). Conclusion: In our setting, RTS is a good predictor of outcome in paediatric trauma patients. It can aid in the assessment of severity of injury in, and objective assessment and triaging of paediatric trauma patients.

References

Peclet MH, Newman KD, Eichelberger MR, Gotschall CS, Guzzetta PC, Anderson KD, et al. Patterns of injury in children. J Pediatr Surg 1990;25(1):85–90.

Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study. Lancet 1997;349(9064):1498–504.

Fatmi Z, Kazi A, Hadden WC, Bhutta ZA, Razzak JA, Pappas G. Incidence and pattern of unintentional injuries and resulting disability among children under 5 years of age: results of the National Health Survey of Pakistan. Paediatr Perinat Epidemiol 2009;23(3):229–38.

Ghaffar A, Hyder AA, Mastoor MI, Shaikh I. Injuries in Pakistan: directions for future health policy. Health Policy Plan 1999;14(1):11–7.

Fatmi Z, Hadden WC, Razzak JA, Qureshi HI, Hyder AA, Pappas G. Incidence, patterns and severity of reported unintentional injuries in Pakistan for persons five years and older: results of the National Health Survey of Pakistan 1990-94. BMC Public Health 2007;7:152.

Bouillon B, Neugebauer E, Rixen D, Lefering R, Tiling T. [Value of clinical scoring systems for evaluation of injury severity and as an instrument for quality management of severely injured patients]. Zentralbl Chir 1996;121(11):914–23.

Narci A, Solak O, Turhan-Haktanir N, Aycicek A, Demir Y, Ela Y, et al. The prognostic importance of trauma scoring systems in pediatric patients. Pediatr Surg Int 2009;25(1):25–30.

Sharma BR. Triage in trauma-care system: a forensic view. J Clin Forensic Med 2005;12(2):64–73.

Oyetunji T, Crompton JG, Efron DT, Haut ER, Chang DC, Cornwell EE 3rd, et al. Simplifying Physiologic Injury Severity Measurement for Predicting Trauma Outcomes. J Surg Res 2010;159(2):627–32.

Gabbe BJ, Cameron PA, Finch CF. Is the revised trauma score still useful? ANZ J Surg 2003;73(11):944–8.

Moore L, Lavoie A, LeSage N, Abdous B, Bergeron E, Liberman M, et al. Statistical validation of the Revised Trauma Score. J Trauma 2006;60(2):305–11.

Talwar S, Jain S, Porwal R, Laddha BL, Prasad P. Trauma scoring in a developing country. Singapore Med J. 1999;40(6):386-8.

Miller RS, Patton M, Graham RM, Hollins D. Outcomes of trauma patients who survive prolonged lengths of stay in the intensive care unit. J Trauma 2000;48(2):229–34.

Livingston DH, Tripp T, Biggs C, Lavery RF. A fate worse than death? Long-term outcome of trauma patients admitted to the surgical intensive care unit. J Trauma 2009;67(2):341–8.

Menzin J, Meyers JL, Friedman M, Perfect JR, Langston AA, Danna RP, et al. Mortality, length of hospitalization, and costs associated with invasive fungal infections in high-risk patients. Am J Health Syst Pharm 2009;66(19):1711–7.

Balogh ZJ, Varga E, Tomka J, Suveges G, Toth L, Simonka JA. The new injury severity score is a better predictor of extended hospitalization and intensive care unit admission than the injury severity score in patients with multiple orthopaedic injuries. J Orthop Trauma 2003;17(7):508–12.

Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME. A revision of the Trauma Score. J Trauma 1989;29(5):623–9.

Ahmad HN. Evaluation of revised trauma score in polytraumatized patients. J Coll Physicians Surg Pak 2004;14(5):286–9.

Published

2015-09-30