Predicting mortality in severe polytrauma with limited resources

Area of Science:

• Trauma care research
• Medical scoring systems
• Emergency medicine

Background:

• Objective evaluation of patient severity is vital for effective trauma management and outcome assessment.
• This study compared six trauma scores to identify the best mortality predictors in resource-limited environments.

Purpose of the Study:

• To compare the predictive power of six widely used trauma scores for mortality.
• To identify the most effective trauma score for predicting mortality in limited-resource settings.

Main Methods:

• Seventy-five polytraumatized patients (ISS≥16, SOFA≥5) were analyzed.
• Logistic regression and ROC curve analysis (AUC) were used to evaluate score performance.
• Included scores: Injury Severity Score (ISS), New Injury Severity Score (NISS), APACHE 2, Sequential Organ Failure Assessment (SOFA), Trauma and Injury Severity Score (TRISS), and Kampala Trauma Score (KTS).

Main Results:

• All six trauma scores significantly predicted mortality (p<0.001).
• The TRISS and APACHE 2 scores demonstrated the highest predictive power, with AUCs of 0.9 and 0.866, respectively.
• Cut-off values for mortality prediction were identified for ISS, NISS, APACHE 2, and SOFA.

Conclusions:

• APACHE 2 and TRISS are the most powerful mortality predictors in trauma patients, even in resource-limited settings.
• The Kampala Trauma Score (KTS) did not perform as expected despite statistical significance.
• Recommended use: KTS for the 'golden hour,' ISS or NISS upon admission, and APACHE 2 or TRISS within 24 hours of ICU admission.