A comparison of trauma scoring systems for trauma-related injuries presenting to a districtlevel urban public hospital in Western Cape, South Africa

Abstract

Background: Trauma is a major public health issue and has an extensive burden on the health system in South Africa. Many trauma scoring systems  have been developed to estimate trauma severity and predict mortality. The prediction of mortality between different trauma scoring systems have not  been compared at district-level health facilities in South Africa. The objective was to compare four trauma scoring systems (injury severity score (ISS),  revised trauma score (RTS), Kampala trauma score (KTS), trauma and injury severity score (TRISS)) in predicting mortality in trauma-related patients  presenting to a district-level hospital in Cape Town.

Methods: A retrospective analysis of all trauma patients managed in the resuscitation unit of Khayelitsha Hospital during a six-month period. Logistic  regression was done, and empirical cut of points used to maximise sensitivity and specificity on receiver operating characteristic curves. The outcome  was all-cause in-hospital mortality.

Results: In total, 868 participants were analysed after 50 were excluded due to missing data. The mean (± SD) age was 28±11 years, 726 (83.6%) were  males, and penetrating injuries (n = 492,56.6%) dominated. The mortality rate was 5.2% (n = 45). TRISS was the best mortality predictor (c-statistic 0.93,  sensitivity 90%, specificity 87%). All scoring systems had overlapping confidence intervals.

Conclusion: TRISS, ISS, RTS and KTS performed equivocally in predicting mortality in trauma-related patients managed at a district-level facility. The  appropriate scoring system should be the simplest one which can be practically implemented and will likely differ between facilities.