Outcome of major trauma at Mulago Hospital in Uganda. Assessment using the TRISS methodology

Abstract

A prospective study of 150 patients presenting with major trauma (ISS >15) at  Mulago Hospital, Kampala over a period of 11 months starting from 1"' February 1998 was undertaken with the main objective of determining the trauma outcome using the TRISS methodology. Injury severity scores (ISS), Revised Trauma scores (RTS), age, sex, cause of trauma, investigations performed and treatment given were recorded. Using the TRISS methodology, and basing on the major trauma outcome study (MTOS) norms of North America, PRE-charts were construited to determine the outcome. Patients' follow up was Limited to two weeks. Autopsies were done for patients who died during the study period. The study population included 132 males and 18 females. Seventy-four percent of the patients were aged less than 40 years. The majority (86.7%) of the cases sustained blunt injuries.  Road traffic injuries accounted for 75% of the cases and these were followed by assaults in 21% of the cases. The mean ISS for the survivors was 20 and 29 for  non-survivors. There were 39 deaths (26% mortality rate), 25 (64.1%) of which were unexpected using the TRISS methodology. Of these 24 were deemed  preventable by peer review The following statistics were obtained: 2=6.838, W=14 and M=0.719, indicating that the performance of Mulago Hospital in trauma care  was worse than expected basing'our assessment on the North American standards. The leading causes of death were intracranial haematoma (46%) and haemorrhagic  shock (41%). Twenty-three (59%) of the death occurred on the frrst day of injury. Missed injuries contributed 13 (54%) of the preventable deaths. In conclusion, major trauma outcome in Mulago Hospital is far below expectations using the MTOS trauma outcome norms. Most preventable deaths were due to missed injuries.

Key words: Trauma, outcome TRISS methodology.