Injury Severity Score as a Predictor of Mortality in Patients with Abdominal Trauma at a Tertiary Nigerian Hospital

Abstract

Background: Abdominal trauma is a major cause of morbidity and mortality in low-and middle-income countries. Typical patients present late and very  sick with early recognition key to improving outcome. There is a paucity of trauma data in this environment and trauma scoring systems which have been  validated in the developed world are yet to find widespread use here.

Aim: This study aimed at evaluating role of injury severity score (ISS) in  predicting mortality.

Patients and Methods: This is a retrospective observational study of patients with abdominal trauma who presented at the  University of Ilorin Teaching Hospital from 2013 to 2019. Records were identified and data were extracted and analyzed using Statistical package for  social sciences 23.

Results: A total of 87 patients were included in the study. There were 73 males and 14 females. The mean overall ISS in this study was  16.06 ± 7.9. Concerning morbidity, the area under the receiver operating characteristic curve in predicting morbidity was 0.843 (95% confidence interval  0.737‑0.928). ISS had a strong sensitivity of 90% and specificity 55% at a cut‑off of 14.50. Also, the area under the receiver operating characteristic curve in  predicting mortality was 0.746 (95% confidence interval 0.588‑0.908) and at a cut‑off of 16.50; ISS had a specificity of 80% and sensitivity of 60%. The  mean ISS of patients with mortality was 22.60 ± 10.5 while the survivors had a mean ISS of 14.7 ± 6.5 (P <.001). The mean ISS for patients who had  morbidity was 22.8 ± 8.1 while those without morbidity had a mean ISS of 13.1 ± 5.7 (P <.05).

Conclusion: ISS was a good predictor of morbidity and  mortality in abdominal trauma in patients in this study. A prospective study with standardized abdominal imaging would be needed to further validate  this scoring tool.