Use of Ganga Hospital Open Injury Severity Scoring for determination of salvage versus amputation in open type IIIB injuries of lower limbs in children—An analysis of 52 type IIIB open fractures

Venkatadass, K.; Grandhi, Tarani Sai Prasanth; Rajasekaran, Shanmuganathan

doi:10.1016/j.injury.2017.09.010

Cited by 16 publications

(13 citation statements)

References 13 publications

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“…It has shown greater sensitivity and specificity in predicting amputation over other severity scores. 14 A cut-off score of 14 (out of 29) has shown good specificity and sensitivity in predicting salvage in open tibial fractures, 15 , 16 and a score of 17 has shown similar efficacy in predicting amputation. 14 , 16 Breakdowns of the score’s parameters are shown in Table 2 .…”

Section: Classificationmentioning

confidence: 99%

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Open fractures of the lower extremity

2018

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Open fractures of the lower extremity are the most common open long bone injuries, yet their management remains a topic of debate.This article discusses the basic tenets of management and the subsequent impact on clinical outcome. These include the rationale for initial debridement, antimicrobial cover, addressing the soft-tissue injury and definitive skeletal management.The classification of injury severity continues to be a useful tool in guiding treatment and predicting outcome and prognosis. The Gustilo-Anderson classification continues to be the mainstay, but the adoption of severity scores such as the Ganga Hospital score may provide additional predictive utility.Recent literature has challenged the perceived need for rapid debridement within 6 hours and the rationale for prolonged antibiotic therapy in the open fracture. The choice of definitive treatment must be decided against known efficacy and injury severity/type.Recent data demonstrate better outcomes with internal fixation methods in most open tibial fractures, but external fixation continues to be an appropriate choice in more severe injuries. The incidence of infection and non-union has decreased with new treatment approaches but continues to be a source of significant morbidity and mortality.Assessment of functional outcome using various measures has been prevalent in the literature, but there is limited consensus regarding the best measures to be used.Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170072

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Section: Classificationmentioning

confidence: 99%

“…21 , 75 - 77 Severity scores may provide a measured value in predicting the need for amputation. 13 , 14 …”

Section: Complications and Outcomesmentioning

confidence: 99%

Open fractures of the lower extremity

2018

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“…It has been suggested that the outcome of the injuries in the gray zone is dependent on noninjury factors such as the skill and experience of the surgical team, the availability of facilities, and the patient's request. GHOISS was reported to be useful in children as well [14]. In their series of 107 patients with type IIIB injury, Rajasekaran et al have reported that the Ganga hospital score showed higher sensitivity and specificity for predicting amputation; however, as they have mentioned in their article, this must be validated with multicenter trials [1].…”

Section: Discussionmentioning

confidence: 97%

Scoring Systems in Major Extremity Traumas

Demir¹,

Karşıdağ²

2020

Limb Amputation

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In the emergency room, every mangled extremity presents with its unique features. Each case requires a different approach and special care, while a surgeon has almost always the same facilities and armamentarium in her/his own setting. Thanks to the advancements in the bone fixation technologies and microsurgical field, the attempts to salvage mangled or even amputated limbs have increased. However, it is still controversial how the decision should be made for salvage or amputation. That is why several scoring systems have been proposed based on retrospective analysis of this group of patients in order to generate a systematic approach and to optimize the outcome. Although they help the surgeon to decide salvation over amputation, or vice versa, the same scores in different patient populations should be interpreted meticulously, and the treatment plan should be established accordingly. The ultimate success is being able to make the most accurate decision possible, and this can be only achieved with experience and extensive knowledge along with sufficient surgical skills.

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“…Regardless, further studies need to be conducted in children, to ascertain the ideal threshold score though a score of 17 has been previously recommended. 1 Another criticism of the GHOISS is that it does not include laboratory values, 22 which may improve accuracy. However, an over-elaborate score, such as the newly proposed Vetrivel Trauma Score, may present interobserver reliability issues translating to poor clinical application.…”

Section: Discussionmentioning

confidence: 99%

Clinical effectiveness of the Ganga Hospital Open Injury Severity Score for limb salvage versus amputation in patients with complex limb injuries

Ndlovu

Naqshband

Masunda

et al. 2023

The Bone & Joint Journal

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Aims Clinical management of open fractures is challenging and frequently requires complex reconstruction procedures. The Gustilo-Anderson classification lacks uniform interpretation, has poor interobserver reliability, and fails to account for injuries to musculotendinous units and bone. The Ganga Hospital Open Injury Severity Score (GHOISS) was designed to address these concerns. The major aim of this review was to ascertain the evidence available on accuracy of the GHOISS in predicting successful limb salvage in patients with mangled limbs. Methods We searched electronic data bases including PubMed, CENTRAL, EMBASE, CINAHL, Scopus, and Web of Science to identify studies that employed the GHOISS risk tool in managing complex limb injuries published from April 2006, when the score was introduced, until April 2021. Primary outcome was the measured sensitivity and specificity of the GHOISS risk tool for predicting amputation at a specified threshold score. Secondary outcomes included length of stay, need for plastic surgery, deep infection rate, time to fracture union, and functional outcome measures. Diagnostic test accuracy meta-analysis was performed using a random effects bivariate binomial model. Results We identified 1,304 records, of which six prospective cohort studies and two retrospective cohort studies evaluating a total of 788 patients were deemed eligible for inclusion. A diagnostic test meta-analysis conducted on five cohort studies, with 474 participants, showed that GHOISS at a threshold score of 14 has a pooled sensitivity of 93.4% (95% confidence interval (CI) 78.4 to 98.2) and a specificity of 95% (95% CI 88.7 to 97.9) for predicting primary or secondary amputations in people with complex lower limb injuries. Conclusion GHOISS is highly accurate in predicting success of limb salvage, and can inform management and predict secondary outcomes. However, there is a need for high-quality multicentre trials to confirm these findings and investigate the effectiveness of the score in children, and in predicting secondary amputations. Cite this article: Bone Joint J 2023;105-B(1):21–28.

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Use of Ganga Hospital Open Injury Severity Scoring for determination of salvage versus amputation in open type IIIB injuries of lower limbs in children—An analysis of 52 type IIIB open fractures

Cited by 16 publications

References 13 publications

Open fractures of the lower extremity

Open fractures of the lower extremity

Scoring Systems in Major Extremity Traumas

Clinical effectiveness of the Ganga Hospital Open Injury Severity Score for limb salvage versus amputation in patients with complex limb injuries

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