Performance of Prognostication Scores for Mortality in Injured Patients in Rwanda.

Autor: Tang OY; Brown University Warren Alpert Medical School, Department, Providence, Rhode Island., Marqués CG; Brown University Warren Alpert Medical School, Department of Emergency Medicine, Providence, Rhode Island., Ndebwanimana V; University of Rwanda, Department of Anesthesia, Emergency Medicine, and Critical Care, Kigali, Rwanda.; Centre Hospitalier Universitaire de Kigali, Department of Accident & Emergency, Kigali, Rwanda., Uwamahoro C; University of Rwanda, Department of Anesthesia, Emergency Medicine, and Critical Care, Kigali, Rwanda.; Centre Hospitalier Universitaire de Kigali, Department of Accident & Emergency, Kigali, Rwanda., Uwamahoro D; University of Rwanda, Department of Anesthesia, Emergency Medicine, and Critical Care, Kigali, Rwanda.; Centre Hospitalier Universitaire de Kigali, Department of Accident & Emergency, Kigali, Rwanda., Lipsman ZW; Kaiser Permanente, GSAA, San Leandro & Fremont Medical Centers, San Leandro, California., Naganathan S; Brown University Warren Alpert Medical School, Department of Emergency Medicine, Providence, Rhode Island., Karim N; Brown University Warren Alpert Medical School, Department of Emergency Medicine, Providence, Rhode Island., Nkeshimana M; University of Rwanda, Department of Anesthesia, Emergency Medicine, and Critical Care, Kigali, Rwanda.; Centre Hospitalier Universitaire de Kigali, Department of Accident & Emergency, Kigali, Rwanda., Levine AC; Brown University Warren Alpert Medical School, Department of Emergency Medicine, Providence, Rhode Island., Stephen A; Brown University Warren Alpert Medical School, Department of Surgery, Providence, Rhode Island., Aluisio AR; Brown University Warren Alpert Medical School, Department of Emergency Medicine, Providence, Rhode Island.
Jazyk: angličtina
Zdroj: The western journal of emergency medicine [West J Emerg Med] 2021 Jan 22; Vol. 22 (2), pp. 435-444. Date of Electronic Publication: 2021 Jan 22.
DOI: 10.5811/westjem.2020.10.48434
Abstrakt: Introduction: While trauma prognostication and triage scores have been designed for use in lower-resourced healthcare settings specifically, the comparative clinical performance between trauma-specific and general triage scores for risk-stratifying injured patients in such settings is not well understood. This study evaluated the Kampala Trauma Score (KTS), Revised Trauma Score (RTS), and Triage Early Warning Score (TEWS) for accuracy in predicting mortality among injured patients seeking emergency department (ED) care at the Centre Hospitalier Universitaire de Kigali (CHUK) in Rwanda.
Methods: A retrospective, randomly sampled cohort of ED patients presenting with injury was accrued from August 2015-July 2016. Primary outcome was 14-day mortality and secondary outcome was overall facility-based mortality. We evaluated summary statistics of the cohort. Bootstrap regression models were used to compare areas under receiver operating curves (AUC) with associated 95% confidence intervals (CI).
Results: Among 617 cases, the median age was 32 years and 73.5% were male. The most frequent mechanism of injury was road traffic incident (56.2%). Predominant anatomical regions of injury were craniofacial (39.3%) and lower extremities (38.7%), and the most common injury types were fracture (46.0%) and contusion (12.0%). Fourteen-day mortality was 2.6% and overall facility-based mortality was 3.4%. For 14-day mortality, TEWS had the highest accuracy (AUC = 0.88, 95% CI, 0.76-1.00), followed by RTS (AUC = 0.73, 95% CI, 0.55-0.92), and then KTS (AUC = 0.65, 95% CI, 0.47-0.84). Similarly, for facility-based mortality, TEWS (AUC = 0.89, 95% CI, 0.79-0.98) had greater accuracy than RTS (AUC = 0.76, 95% CI, 0.61-0.91) and KTS (AUC = 0.68, 95% CI, 0.53-0.83). On pairwise comparisons, RTS had greater prognostic accuracy than KTS for 14-day mortality (P = 0.011) and TEWS had greater accuracy than KTS for overall (P = 0.007) mortality. However, TEWS and RTS accuracy were not significantly different for 14-day mortality (P = 0.864) or facility-based mortality (P = 0.101).
Conclusion: In this cohort of emergently injured patients in Rwanda, the TEWS demonstrated the greatest accuracy for predicting mortality outcomes, with no significant discriminatory benefit found in the use of the trauma-specific RTS or KTS instruments, suggesting that the TEWS is the most clinically useful approach in the setting studied and likely in other similar ED environments.
Databáze: MEDLINE
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