scholarly journals Thefeasibility, appropriateness, and applicability of trauma scoring systems in low and middle-income countries: a systematic review

2020 ◽  
Vol 5 (1) ◽  
pp. e000424
Author(s):  
Isabelle Feldhaus ◽  
Melissa Carvalho ◽  
Ghazel Waiz ◽  
Joel Igu ◽  
Zachary Matthay ◽  
...  
Keyword(s):  
Systematic Review ◽  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Scoring Systems ◽  
Middle Income ◽  
Middle Income Countries ◽  
Trauma Scoring ◽  
Trauma Score ◽  
Low And Middle Income

BackgroundAbout 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.Materials and methodsThis 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.ResultsOf 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.ConclusionsThe 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.PROSPERO registration numberCRD42017064600.

scholarly journals Performance of injury severity measures in trauma research: a literature review and validation analysis of studies from low-income and middle-income countries

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e023161 ◽  
Author(s):  
Amber Mehmood ◽  
Yuen W Hung ◽  
Huan He ◽  
Shahmir Ali ◽  
Abdul M Bachani
Keyword(s):  
Hospital Mortality ◽  
Injury Severity Score ◽  
Low Income ◽  
Severity Score ◽  
Validation Studies ◽  
Injury Severity ◽  
Middle Income ◽  
War Injuries ◽  
Trauma Research ◽  
Middle Income Countries

IntroductionCharacterisation of injury severity is an important pillar of scientific research to measure and compare the outcomes. Although majority of injury severity measures were developed in high-income countries, many have been studied in low-income and middle-income countries (LMICs). We conducted this study to identify and characterise all injury severity measures, describe how widely and frequently they are used in trauma research from LMICs, and summarise the evidence on their performance based on empirical and theoretical validation​ analysis.MethodsFirst, a list of injury measures was identified through PubMed search. Subsequently, a systematic search of PubMed, Global Health and EMBASE was undertaken on LMIC trauma literature published from January 2006 to June 2016, in order to assess the application and performance of injury severity measures to predict in-hospital mortality. Studies that applied one or more global injury severity measure(s) on all types of injuries were included, with the exception of war injuries and isolated organ injuries.ResultsOver a span of 40 years, more than 55 injury severity measures were developed. Out of 3862 non-duplicate citations, 597 studies from 54 LMICs were listed as eligible studies. Full-text review revealed 37 studies describing performance of injury severity measures for outcome prediction. Twenty-five articles from 13 LMICs assessed the validity of at least one injury severity measure for in-hospital mortality. Injury severity score was the most commonly validated measure in LMICs, with a wide range of performance (area under the receiver operating characteristic curve (AUROC) between 0.9 and 0.65). Trauma and Injury Severity Score validation studies reported AUROC between 0.80 and 0.98.ConclusionEmpirical studies from LMICs frequently use injury severity measures, however, no single injury severity measure has shown a consistent result in all settings or populations and thus warrants validation studies for the diversity of LMIC population.

scholarly journals A Comparative Study Between Two Combat Injury Severity Scores

2021 ◽  
Author(s):  
Rafael García Cañas ◽  
Ricardo Navarro Suay ◽  
Carlos Rodríguez Moro ◽  
Diana M Crego Vita ◽  
Javier Arias Díaz ◽  
...  
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Scoring Systems ◽  
Combat Injury ◽  
New Injury Severity Score ◽  
Severity Scores ◽  
Trauma Scoring ◽  
Combat Casualties ◽  
The Military

ABSTRACT Introduction In recent years, specific trauma scoring systems have been developed for military casualties. The objective of this study was to examine the discrepancies in severity scores of combat casualties between the Abbreviated Injury Scale 2005-Military (mAIS) and the Military Combat Injury Scale (MCIS) and a review of the current literature on the application of trauma scoring systems in the military setting. Methods A cross-sectional, descriptive, and retrospective study was conducted between May 1, 2005, and December 31, 2014. The study population consisted of all combat casualties attended in the Spanish Role 2 deployed in Herat (Afghanistan). We used the New Injury Severity Score (NISS) as reference score. Severity of each injury was calculated according to mAIS and MCIS, respectively. The severity of each casualty was calculated according to the NISS based on the mAIS (Military New Injury Severity Score—mNISS) and MCIS (Military Combat Injury Scale-New Injury Severity Score—MCIS-NISS). Casualty severity were grouped by severity levels (mild—scores: 1-8, moderate—scores: 9-15, severe—scores: 16-24, and critical—scores: 25-75). Results Nine hundred and eleven casualties were analyzed. Most were male (96.37%) with a median age of 27 years. Afghan patients comprised 71.13%. Air medevac was the main casualty transportation method (80.13). Explosion (64.76%) and gunshot wound (34.68%) mechanisms predominated. Overall mortality was 3.51%. Median mNISS and MCIS-NISS were similar in nonsurvivors (36 [IQR, 25-49] vs. [IQR, 25-48], respectively) but different in survivors, 9 (IQR, 4-17) vs. 5 (IQR, 2-13), respectively (P < .0001). The mNISS and MCIS-NISS were discordant in 34.35% (n = 313). Among cases with discordant severity scores, the median difference between mNISS and MCIS-NISS was 9 (IQR, 4-16); range, 1 to 57. Conclusion Our study findings suggest that discrepancies in injury severity levels may be observed in one in three of the casualties when using mNISS and MCIS-NISS.

scholarly journals The Most Common Tools to Measure Trauma Severity: A review Study

2019 ◽  
Author(s):  
Abbasali Dehghani Tafti ◽  
Khadijeh Nasiriani ◽  
Majid Hajimaghsoudi ◽  
Mehri Maki ◽  
Samaneh Mirzaei ◽  
...  
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Scoring System ◽  
Injury Severity ◽  
Physiological Parameters ◽  
Assessment Methods ◽  
Assessment Tools ◽  
Trauma Severity ◽  
Trauma Scoring ◽  
Trauma Score

Introduction: Due to the increasing mortality rate from trauma, determining the severity of injury has a very important role in the prognosis of the injured person. On the other hand, the quality of medical care provided to the casualties is evaluated using the Trauma Scoring System. Various scales were used to determine the trauma severity of injured. In this study, the most commonly used tools are investigated. Methods: This review was conducted by searching throughout the Persian data bases of Magiran, Barakat, SID and English databases of Scopus, Web of sciences, PubMed, and Google scholar. To conduct the search, the following keywords were used: "Severity of Trauma", "Trauma scoring", and "Trauma Scoring System" without considering any time intervals. Our early search resulted in 2125 articles. Finally, 17 articles were analyzed and different functions of traumatic assessment tools were compared and studied. Results: Traumatic assessment methods vary based on the anatomical and physiological parameters and composition of these two methods. In this study, the Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), and New Injury Severity Score (NISS) were considered as anatomical parameters; Revised Trauma Score (RTS) as physiological parameters; Trauma Score Injury Severity Score (TRISS) and A Severity Characterization of Trauma (ASCOST) were mentioned as a hybrid ranking system. Conclusion: Application of accurate scientific evaluations in trauma severity assessment methods and application of each method in its appropriate position would result in appropriate improvements in the development of trauma care.  In addition, these systems can play an important role in providing care to patients with traumatic injuries in the present and future.

scholarly journals Performance of critical care prognostic scoring systems in low and middle-income countries: a systematic review

Critical Care ◽  
2018 ◽  
Vol 22 (1) ◽  
Author(s):  
Rashan Haniffa ◽  
Ilhaam Isaam ◽  
A. Pubudu De Silva ◽  
Arjen M. Dondorp ◽  
Nicolette F. De Keizer
Keyword(s):  
Systematic Review ◽  
Critical Care ◽  
Scoring Systems ◽  
Middle Income ◽  
Middle Income Countries ◽  
Prognostic Scoring Systems ◽  
Low And Middle Income

scholarly journals Pattern of Severity of Road Traffic Injuries Among Pedestrians in Low- and Middle-Income Countries: A Systematic Review

2021 ◽  
Author(s):  
Neeraj Sharma ◽  
Mohan Bairwa ◽  
S. D. Gupta ◽  
D. K. Mangal
Keyword(s):  
Systematic Review ◽  
Injury Severity ◽  
Road Traffic ◽  
Sub Saharan Africa ◽  
Middle Income ◽  
Road Traffic Injuries ◽  
Middle Income Countries ◽  
Sub Saharan ◽  
Low And Middle Income

ABSTRACTBackgroundLow-and middle-income countries (LMICs) contribute about 93 per cent of road traffic injuries (RTIs) and deaths worldwide with a significant proportion of pedestrians (22 per cent). Various scales are used to assess the pattern of injury severity, which are useful in predicting the outcomes of RTIs. We conducted this systematic review to determine the pattern of RTI severity among pedestrians in LMICs.MethodsWe searched the electronic databases PubMed, CINHAL, CENTRAL, Web of Science, Scopus, EMBASE, ProQuest and SciELO, and examined the references of the selected studies. Original research articles published on the RTI severity among pedestrians in LMICs during 1997-2016 were eligible for this review. Quality of publications was assessed using an adapted Newcastle-Ottawa Scale of observational studies. Findings of this study were presented as a meta-summary.ResultsFive articles from 3 LMICs were eligible for the systematic review. Abbreviated Injury Score, Glasgow Coma Scale and Maxillofacial Injury Severity Score were used to assess the injury severity in the selected studies. In a multicentric study from China (2013), 21, 38 and 19 per cent pedestrians with head injuries had AIS scores 1-2, 3-4 and 5-6, respectively. In another study from China (2010), the proportion of AIS score 1-2 and AIS score 3 and above (serious to un-survivable) injuries occurred due to crash with sedan cars were 65 and 35 per cent, respectively. Such injuries due to minivan crashes were 49.5 per cent and 50.5 per cent, respectively. Two studies Ikeja, Nigeria (2014) and Elazig, Turkey (2009) presented, 24.5 and 32.5 per cent injured had a severe head injury (GCS < 8), respectively. In another study from Ibadan, Nigeria (2014), the severe maxillofacial injuries were seen in the victims of car/minibus pedestrian crashes 46 per cent, and 17 per cent had a fatal outcome.ConclusionA varied percent of pedestrians (24.5 to 57 percent) had road traffic injuries of serious to fatal nature, depending on type of collision and injury severity scale. This study pressed the need to conduct studies with a robust methodology on the pattern of RTI severity among pedestrians to guide the programme managers, researchers and policymakers in LMICs to formulate the policies and programmes to save the pedestrian lives.African relevancePrior RTI research reveals that pedestrians and cyclists were at the highest risk of fatality of in Sub-Saharan Africa, whereas motorcyclists had significantly higher fatality rates in Asian countries such as Malaysia and Thailand (1–3).Fifty-seven type of injury severity scoring systems have been developed to assess the injury severity for triage and timely decision making for patient treatment need, outcome prediction, quality of trauma care, and epidemiological research and evaluation (4,5).We found two studies from sub-Saharan Africa in this review which showed that severe pedestrian injuries ranged from 24.5 to 46 per cent of total pedestrian RTIs.Despite the findings of review affected by limited and variegated sample, it could be useful to guide for future research.

scholarly journals Aplikasi revised trauma score, injury severity score, dan trauma and injury severity score dalam memrediksi mortalitas pada pasien multitrauma di IRDB BLU RSUP Prof. Dr. R. D. Kandou Manado

2016 ◽  
Vol 8 (2) ◽  
Author(s):  
Jassy S. R. Ranti ◽  
Heber B. Sapan ◽  
Laurens T. B. Kalesaran
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Scoring System ◽  
Traffic Accidents ◽  
Injury Severity ◽  
Scoring Systems ◽  
Correlation Study ◽  
Trauma Studies ◽  
Revised Trauma Score ◽  
Trauma Score

Abstract: Trauma is the main cause of deaths among teenagers and young adults. Most of the cases are due to traffic accidents, therefore, a scoring system that can transforms the trauma quality to numbers is very valuable. This scoring system is needed to predict mortality, compare therapeutic methods, function as a triage tool pre hospitalization and during the way to the hospital, evaluate quality improvement and prevention program, and as a tool in trauma studies. There are several available scoring systems usually used in trauma studies, as follows: Revised Trauma Score (RTS), Injury Severity Score (ISS), and Trauma Related Injury Severity Score (TRISS). This study aimed to obtain the easiest applicable scoring system to multitraumatic patients in Prof. Dr. R. D. Kandou Hospital Manado. This was an observational correlation study. Evaluation of mortality was done by using the scoring systems and then was compared to the results in the field. There were 37 multitraumatic patients consisted of 30 males and 7 females. Five patients died during this study. By using RTS, of score >7 there was 1 death; of score 6-7 there were 3 deaths; and of score-5 there was 1 death. By using ISS, all dead patients had score ≥25, meanwhile by using TRISS, 2 dead patients had score 81-100,1 dead patient had score 61-80, and 2 dead patients had score 41-60. Conclusion: RTS is the easiest applicable scoring system at triage and pre-hospitalization, and is recommended to be a part of management of multitraumatic patients. Along with ISS, RTS can be used as a mortality predictor among multitraumatic patients.Keywords: trauma, RTS, ISS, TRISS, mortalityAbstrak: Trauma merupakan penyebab kematian utama pada usia remaja dan dewasa muda. Sistim penilaian (skoring) yang dapat mengubah kualitas trauma ke dalam bentuk nilai diperlukan agar dapat meramalkan mortalitas, membandingkan metode terapi, merupakan alat triase pre- dan antar rumah sakit, menilai perbaikan kualitas dan program pencegahan, serta merupakan alat dalam studi trauma. Beberapa sistem skoring yang sering digunakan dalam penelitian ialah Revised Trauma Score (RTS), Injury Severity Score (ISS), dan Trauma Related Injury Severity Score (TRISS). Penelitian ini bertujuan untuk mendapatkan pilihan sistim skoring yang paling mudah diaplikasikan pada pasien multitrauma di BLU RSUP Prof. Dr. R. D. Kandou, Manado. Jenis penelitian ialah observasional korelatif. Penilaian ini mengaplikasikan masing-masing skor terhadap angka mortalitas dan dibandingkan dengan hasil yang diperoleh di lapangan. Dalam penelitian ini terdapat 37 pasien multitrauma, terdiri dari 30 laki-laki dan 7 perempuan. Jumlah pasien yang meninggal selama penelitian ialah 5 orang. Untuk RTS, dari pasien dengan skor >7 terdapat 1 kematian; dari pasien dengan skor 6-7 terdapat 3 kematian, dan dari pasien dengan skor 5 terdapat 1 kematian. Untuk ISS, semua pasien yang meninggal memiliki skor ≥25, sedangkan untuk TRISS, 2 pasien yang meninggal dengan skor 81-100, 1 pasien dengan skore 61-80, dan 2 pasien yang meninggal dengan skor 41-60. Simpulan: RTS paling mudah diaplikasikan saat triase dan fase pre rumah sakit, serta direkomendasikan untuk menjadi bagian dari pedoman penanganan kasus multitrauma. Bersama-sama dengan ISS, RTS dapat diaplikasikan sebagai prediktor mortalitas pasien multitrauma.Kata kunci: trauma, RTS, ISS, TRISS, mortalitas

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