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Registry based trauma outcome: perspective of a developing country
1Department of Surgery, The Aga Khan University, Karachi, Pakistan. hasnain.zafar@aku.edu
Emergency Medicine Journal : EMJ
|September 3, 2002
Summary
Trauma outcomes in developing countries may not align with predictions from standard scoring systems like TRISS. This study found that injury severity instruments using MTOS coefficients inaccurately predicted survival rates in a developing nation.
Area of Science:
- Traumatology
- Public Health
- Health Services Research
Background:
- Trauma outcome prediction is crucial for resource allocation and quality improvement.
- Existing trauma scoring systems, like the Trauma and Injury Severity Scoring (TRISS) method, are primarily developed from data in high-income countries.
- The applicability of these systems in developing countries with different healthcare infrastructures and patient demographics is uncertain.
Purpose of the Study:
- To evaluate trauma patient outcomes in a developing country using the TRISS methodology.
- To compare observed outcomes with predictions derived from the Major Trauma Outcome Study (MTOS) registry data.
Main Methods:
- A registry-based audit of all trauma patients admitted over a two-year period at a teaching university hospital.
- Application of TRISS methodology, including W, M, and Z statistics, to compare expected versus observed outcomes.
- Comparison of the study cohort with the MTOS dataset.
Main Results:
- The study included 279 trauma patients, with blunt injuries being more common (73.1%).
- A significant proportion (50.9%) were transferred from other facilities, with a mean prehospital delay of 7.1 hours.
- The M statistic indicated a good match with the MTOS cohort, but observed deaths (18) exceeded expected deaths (12) based on MTOS coefficients, with only one unexpected survivor.
Conclusions:
- Current injury severity instruments, when utilizing MTOS coefficients, do not accurately predict survival rates in the context of a developing country.
- There is a need to refine or develop new trauma outcome prediction models that account for the unique characteristics of trauma care in developing nations.