Using the Revised Trauma Score to Predict Outcome in Severely Head Injured Patients in a Developing Nation – A Pilot Study.

Abstract

Background: A prospective study on the relationship between the weighted revised trauma score and patient outcome (mortality) was carried out at National hospital, Abuja, Nigeria from April to December 2005.
Methods: The patients\' demographics were collected. The duration of stay in the intensive care unit was also noted. The weighted RTS was used in this study. The sum of coded values of Glasgow coma scale (GCS) score, systolic blood pressure (SBP) and respiratory rate (RR) were calculated and documented. These parameters were recorded at the accident and emergency department and calculated in the ICU.
Results: The records of 38 head injured trauma patients admitted to the general ICU of National Hospital, Abuja, Nigeria over a nine-month period (April - December 2005) were analyzed. The average age of the patients was 36.18 years (range 4 - 65 yr.) There were thirty-four males amongst the patients. The average duration of stay in the ICU was 9.05 days (range 1-43 days). Three patients (8%) had surgical intervention. Only one patient with RTS of less than 5.6 survived (4.093). Twelve patients survived (31.6%). Five patients (13.1%) with RTS greater than 5.6 died (complicated by cervical spine injury in two patients and basal skull fracture in three others).
Conclusion: The results in this study revealed that though the weighted RTS was effective in determining mortality outcome in head injured patients, the mortality rate in this study was high because of delayed transfer of patients due to poor ambulance services, associated cervical spine injuries and gunshot injuries to the head.
Improvement of referral and ambulance services may help reduce this high rate. This study reemphasized the fact that the weighted score of the RTS is a good predictor of both severity of head injury (and thus the need for ICU admission) and mortality.


Keywords: Revised Trauma Score; Severely Head Injured Patients; Developing Nation

Journal of College of Medicine Vol. 12 (2) 2007: pp. 51-55