Evaluating trauma scoring systems for patients presenting with gunshot injuries to a district-level urban public hospital in Cape Town, South Africa

Abstract

IntroductionTrauma scoring systems are widely used in emergency settings to guide clinical decisions and to predict mortality. It remains unclear which system is most suitable to use for patients with gunshot injuries at district-level hospitals. This study compares the Triage Early Warning Score (TEWS), Injury Severity Score (ISS), Trauma and Injury Severity Score (TRISS), Kampala Trauma Score (KTS) and Revised Trauma Score (RTS) as predictors of mortality among patients with gunshot injuries at a district-level urban public hospital in Cape Town, South Africa.MethodsGunshot-related patients admitted to the resuscitation area of Khayelitsha Hospital between 1 January 2016 and 31 December 2017 were retrospectively analysed. Receiver Operating Characteristic (ROC) analysis were used to determine the accuracy of each score to predict all-cause in-hospital mortality. The odds ratio (with 95% confidence intervals) was used as a measure of association.ResultsIn total, 331 patients were included in analysing the different scores (abstracted from database n = 431, excluded: missing files n = 16, non gunshot injury n = 10, <14 years n = 1, information incomplete to calculate scores n = 73). The mortality rate was 6% (n = 20). The TRISS and KTS had the highest area under the ROC curve (AUC), 0.90 (95% CI 0.83-0.96) and 0.86 (95% CI 0.79–0.94), respectively. The KTS had the highest sensitivity (90%, 95% CI 68-99%), while the TEWS and RTS had the highest specificity (91%, 95% CI 87–94% each).ConclusionsNone of the different scoring systems performed better in predicting mortality in this high-trauma burden area. The results are limited by the low number of recorded deaths and further studies are needed.

Gunshot injuries: patterns, presentations, and outcomes of civilian hospital experiences in a developing country setting

“…Conversely, the perineum was found to be the least affected site (2%). These ndings are like those reported in previous literature [6,8,13].…”

“…Our data showed limbs fracture with local soft tissue injuries as the most common presenting diagnosis, followed by visceral perforations, rib fractures and head injuries. These ndings are similar to studies conducted previously [8,13,14].…”

“…In this study, we reviewed the data (clinical presentation, treatments and management outcome) of 157 patients presented to the hospital with gunshot wounds due to various causes in the period of January 2014 to January 2019 to assess the pattern, causes, management and the outcome. The total number of patients reviewed in this study is same or slightly higher than some an available national and international [6,11,12] data but still less than reported number from USA and South Africa [8,13,14].…”

“…South Africa is an example of a country that faces this problem, which creates a huge burden on the healthcare resources [7]. Firearm injuries were estimated to amount to almost 55,000 in 2012 in South Africa [8].…”

Gunshot Injuries: Patterns, Presentations, and Outcomes of Civilian Hospital Experiences in a Developing Country Setting

“…Our data showed limbs fracture with local soft tissue injuries as the most common presenting diagnosis, followed by visceral perforations, rib fractures and head injuries. These ndings are like studies conducted previously [8,13,14].…”