Citation

Aspelund AL, Patel MQ, Kurland L, McCaul M, Van Hoving DJ. Afr. J. Emerg. Med. 2019; 9(4): 193-196.

Affiliation

Division of Emergency Medicine, Stellenbosch University, Cape Town, South Africa.

Copyright

(Copyright © 2019, African Federation for Emergency Medicine, Publisher Elsevier Publishing)

DOI

10.1016/j.afjem.2019.07.004

PMID

31890483

PMCID

PMC6933194

Abstract

INTRODUCTION: Trauma scoring systems are widely used in emergency settings to guide clinical decisions and to predict mortality. It remains unclear which system is most suitable to use for patients with gunshot injuries at district-level hospitals. This study compares the Triage Early Warning Score (TEWS), Injury Severity Score (ISS), Trauma and Injury Severity Score (TRISS), Kampala Trauma Score (KTS) and Revised Trauma Score (RTS) as predictors of mortality among patients with gunshot injuries at a district-level urban public hospital in Cape Town, South Africa.

METHODS: Gunshot-related patients admitted to the resuscitation area of Khayelitsha Hospital between 1 January 2016 and 31 December 2017 were retrospectively analysed. Receiver Operating Characteristic (ROC) analysis were used to determine the accuracy of each score to predict all-cause in-hospital mortality. The odds ratio (with 95% confidence intervals) was used as a measure of association.

RESULTS: In total, 331 patients were included in analysing the different scores (abstracted from database n = 431, excluded: missing files n = 16, non gunshot injury n = 10, <14 years n = 1, information incomplete to calculate scores n = 73). The mortality rate was 6% (n = 20). The TRISS and KTS had the highest area under the ROC curve (AUC), 0.90 (95% CI 0.83-0.96) and 0.86 (95% CI 0.79-0.94), respectively. The KTS had the highest sensitivity (90%, 95% CI 68-99%), while the TEWS and RTS had the highest specificity (91%, 95% CI 87-94% each).

CONCLUSIONS: None of the different scoring systems performed better in predicting mortality in this high-trauma burden area. The results are limited by the low number of recorded deaths and further studies are needed.

2019 African Federation for Emergency Medicine. Publishing services provided by Elsevier.

Language: en

Keywords

Gunshot; Mortality; Prediction; Severity; South Africa; Trauma