Back to the basics: Clinical assessment yields robust mortality prediction and increased feasibility in low resource settings.

Autor:	Yost MT; Department of Surgery, Program for the Advancement of Surgical Equity, University of California Los Angeles, Los Angeles, California, United States of America., Carvalho MM; Department of Surgery, Program for the Advancement of Surgical Equity, University of California Los Angeles, Los Angeles, California, United States of America., Mbuh L; Faculty of Health Sciences, University of Buea, Buea, Cameroon., Dissak-Delon FN; Littoral Regional Delegation, Ministry of Public Health, Yaoundé, Cameroon., Oke R; Department of Surgery, Program for the Advancement of Surgical Equity, University of California Los Angeles, Los Angeles, California, United States of America., Guidam D; Faculty of Health Sciences, University of Buea, Buea, Cameroon., Nlong RM; Faculty of Health Sciences, University of Buea, Buea, Cameroon., Zikirou MM; Faculty of Health Sciences, University of Buea, Buea, Cameroon., Mekolo D; Faculty of Health Sciences, University of Buea, Buea, Cameroon., Banaken LH; Faculty of Health Sciences, University of Buea, Buea, Cameroon., Juillard C; Department of Surgery, Program for the Advancement of Surgical Equity, University of California Los Angeles, Los Angeles, California, United States of America., Chichom-Mefire A; Faculty of Health Sciences, University of Buea, Buea, Cameroon., Christie SA; Department of Surgery, Program for the Advancement of Surgical Equity, University of California Los Angeles, Los Angeles, California, United States of America.
Jazyk:	angličtina
Zdroj:	PLOS global public health [PLOS Glob Public Health] 2023 Mar 29; Vol. 3 (3), pp. e0001761. Date of Electronic Publication: 2023 Mar 29 (Print Publication: 2023).
DOI:	10.1371/journal.pgph.0001761
Abstrakt:	Introduction: Mortality prediction aids clinical decision-making and is necessary for trauma quality improvement initiatives. Conventional injury severity scores are often not feasible in low-resource settings. We hypothesize that clinician assessment will be more feasible and have comparable discrimination of mortality compared to conventional scores in low and middle-income countries (LMICs). Methods: Between 2017 and 2019, injury data were collected from all injured patients as part of a prospective, four-hospital trauma registry in Cameroon. Clinicians used physical exam at presentation to assign a highest estimated abbreviated injury scale (HEAIS) for each patient. Discrimination of hospital mortality was evaluated using receiver operating characteristic curves. Discrimination of HEAIS was compared with conventional scores. Data missingness for each score was reported. Results: Of 9,635 presenting with injuries, there were 206 in-hospital deaths (2.2%). Compared to 97.5% of patients with HEAIS scores, only 33.2% had sufficient data to calculate a Revised Trauma Score (RTS) and 24.8% had data to calculate a Kampala Trauma Score (KTS). Data from 2,328 patients with all scores was used to compare models. Although statistically inferior to the prediction generated by RTS (AUC 0.92-0.98) and KTS (AUC 0.93-0.99), HEAIS provided excellent overall discrimination of mortality (AUC 0.84-0.92). Among 9,269 patients with HEAIS scores was strongly predictive of mortality (AUC 0.93-0.96). Conclusion: Clinical assessment of injury severity using HEAIS strongly predicts hospital mortality and far exceeds conventional scores in feasibility. In contexts where traditional scoring systems are not feasible, utilization of HEAIS could facilitate improved data quality and expand access to quality improvement programming. Competing Interests: The authors have declared that no competing interests exist. (Copyright: © 2023 Yost et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze:	MEDLINE
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