Table 1 - uploaded by Andres Mariano Rubiano Escobar
Content may be subject to copyright.
Kampala trauma score
Source publication
Introduction
To date, no trauma scoring system has emerged as the gold standard for use in developing countries, where limited resources for data collection are a major issue. The purpose of this study is to compare the relatively recently developed and simply calculated KTS (Kampala Trauma Score) with the more widely used RTS (Revised Trauma Score...
Context in source publication
Similar publications
This paper shows how the basic elements of a Petri Net are represented in a Petri Net simulator as data structures, and how they contribute to the efficiency of the simulator. After a brief introduction to Petri Nets, this work presents a new Petri Nets based approach known as Activity-Oriented Petri Nets (AOPN), and then the simulator GPen SIM as...
Citations
... Revised Trauma Score = (0.9368 x GCS Value) + (0.7326 x SBP Value) + (0.2908 x RR Value) At a fixed sensitivity of 90%, the RTS is shown to be a more reliable predictor of death than the Kampala Trauma Score (KTS), with statistical significance only being obtained for an enhanced specificity (67% vs. 47%; p 0.001) [17]. ...
Background: Coma is the main complications after traumatic brain injury. Auditory stimulation is a type of stimulation that can enhance the environment and raise comatose patients' levels of arousal and awareness. Purpose: to examine the effects of direct auditory stimulation program on coma arousal among patients with traumatic brain injury. Design: A quasi experimental (experimental / control) design. Setting: Neurosurgical intensive care units, Menoufia University Hospital, Menoufia. Sample: A convenient sample of sixty adult patients. Instruments: a) A Semi Structured Demographic Sheet b) Revised Trauma Score c) Bispectral Index Number d) Glasgow Coma Scale. Result: After intervention, GCS was significantly improved in the experimental group(13.40 ±1.22) in comparison with the control group (9.90 ±1.47) (P<0.001), Bispectral number was significantly increased in the experimental group (86.26 ±7.29) in comparison with the control group (73.06 ±7.01) (P< 0.001), and ICU length of stay was significantly reduced in the e x p e r i m e n t a l group (9.630 ±2.59) compared to the control group (13.30 ±2.77) (P< 0.001). Conclusion: Direct auditory stimulation program affect GCS and Bispectral index number positively. Recommendation: Auditory stimulation program should be incorporated as a routine hospital care for comatose patients with TBI to enhance consciousness.
... A study from Colombia proved that KTS performed better in predicting death and length of hospitalization than the RTS [17]. The authors of this study conclude, based on solid evidence, that KTS is the simplest method for predicting the lethal outcome in patients because it uses the AVPU system, which is a simpler version of the GKS for determining the patient's neurological status (Alert -awake, fully aware, oriented; V (reaction to verbal stimuli) -reacts to the sound of a voice but is not fully aware, confused; P (reaction to painful stimuli) -unconscious, reacts to painful stimuli; U (unresponsive) -unconscious, does not respond to painful stimuli, has no cough and vomiting reflexes). ...
Severe trauma is the main cause of mortality and disability in modern society. Emergency medical doctors are usually the first to establish contact with the injured person, and the extent of definitive care largely depends on their correct assessment of the severity of the injury, using an adequate pre-hospital trauma score. Injury severity scores are used to numerically categorize the type and extent of the injury. They represent an important additional instrument, which is used to enable faster triage, the categorization of injury severity, adequate care, treatment, and transport of patients with multiple injuries to the appropriate hospital. They are also important in research. This paper aims to suggest, using several case reports, the possibility of pre-hospital use of the Kampala Trauma Score (KTS) as an easily applicable and very suitable system for monitoring the condition and predicting the outcome of seriously injured patients. The patients were primarily assessed at the pre-hospital level and assigned a certain injury severity score according to the KTS, which later proved to reflect their definitive outcome. It can be concluded that the KTS is an effective scoring system that can be used during initial triage of the seriously injured for categorization of the severity of the injury, prediction of mortality and necessity of hospitalization. The possibility of its potential application during emergency care of the seriously injured, both for differentiating the severity of injuries and for predicting the definitive outcome, is indicated. However, due to the limited number of patients, original research should be conducted on a larger sample.
... However, the prognostic value of the GCS is increased by taking other variables into account as well, such as mechanism of injury, age, head computed tomography (CT) findings, papillary abnormalities, and episodes of hypoxia and hypotension [6,7]. e Kampala Trauma Score is a validated tool for assessing the severity of injury in low-resource settings [8][9][10]. Previous studies performed in low-and middleincome countries showed that both the GCS and the KTS were effective triage tools that could independently predict mortality and length of hospital stay. ...
... e age and sex profile of this study is consistent with previous studies [6,8,[11][12][13]. Males in their productive age contributing the greatest proportion of patients at 78.4% with the majority 129 (67.9%) in the 18-34 age group, which is consistent with the vastly young population in Uganda [14]. ...
Introduction. The prevalence rates of head injury have been shown to be as high as 25% among trauma patients with severe head injury contributing to about 31% of all trauma deaths. Triage utilizes numerical cutoff points along the scores continuum to predict the greatest number of people who would have a poor outcome, “severe” patients, when scoring below the threshold and a good outcome “non severe” patients, when scoring above the cutoff or numerical threshold. This study aimed to compare the predictive value of the Glasgow Coma Scale and the Kampala Trauma Score for mortality and length of hospital stay at a tertiary hospital in Uganda. Methods. A diagnostic prospective study was conducted from January 12, 2018 to March 16, 2018. We recruited patients with head injury admitted to the accidents and emergency department who met the inclusion criteria for the study. Data on patient’s demographic characteristics, mechanisms of injury, category of road use, and classification of injury according to the GCS and KTS at initial contact and at 24 hours were collected. The receiver operating characteristics (ROC) analysis and logistic regression analysis were used for comparison. Results. The GCS predicted mortality and length of hospital stay with the GCS at admission with AUC of 0.9048 and 0.7972, respectively (KTS at admission time, AUC 0.8178 and 0.7243). The GCS predicted mortality and length of hospital stay with the GCS at 24 hours with AUC of 0.9567 and 0.8203, respectively (KTS at 24 hours, AUC 0.8531 and 0.7276). At admission, the GCS at a cutoff of 11 had a sensitivity of 83.23% and specificity of 82.61% while the KTS had 88.02% and 73.91%, respectively, at a cutoff of 13 for predicting mortality. At admission, the GCS at a cutoff of 13 had sensitivity of 70.48% and specificity of 66.67% while the KTS had 68.07% and 62.50%, respectively, at a cutoff of 14 for predicting length of hospital stay. Conclusion. Comparatively, the GCS performed better than the KTS in predicting mortality and length of hospital stay. The GCS was also more accurate at labelling the head injury patients who died as severely injured as opposed to the KTS that categorized most of them as moderately injured. In general, the two scores were sensitive at detection of mortality and length of hospital stay among the study population.
1. Introduction
The term head injury is commonly used to describe injuries affecting not just the brain but also the scalp, skull, maxilla, mandible, and special senses of smell, vision, and hearing. Head injuries are also commonly referred to as brain injury or traumatic brain injury, depending on the extent of the head trauma [1]. In Uganda, head injury is one of the top four common admission diagnoses, contributing to a total 45.3% mortality rate in one study of intensive care unit patients and 75% head injury specific mortality rate in another study of all casualty admissions [2, 3]. Head injury was also found to be associated with 65% of all injury-related fatalities in urban Uganda [4]. With such high mortality rates, there is need for a clinical tool that is simple and easily reproducible that can be used to assess injury severity and more accurately predict mortality and length of hospital stay. In an international cohort study, trial results of 8937 patients predicted that a traumatic brain injury victim in low- and middle-income countries has twice the odds of dying after severe traumatic brain injury. Improvement in the assessment and prioritization of injuries has been shown to contribute to a 28% reduction in fatality rates in injury patients [5]. The Glasgow Coma Scale is a significant predictor of outcome following head injury. However, the prognostic value of the GCS is increased by taking other variables into account as well, such as mechanism of injury, age, head computed tomography (CT) findings, papillary abnormalities, and episodes of hypoxia and hypotension [6, 7]. The Kampala Trauma Score is a validated tool for assessing the severity of injury in low-resource settings [8–10]. Previous studies performed in low- and middle-income countries showed that both the GCS and the KTS were effective triage tools that could independently predict mortality and length of hospital stay. However, no study has been performed to compare the predictive value of the GCS and KTS for mortality and length of hospital stay among head injury patients at a tertiary hospital in low- and middle-income countries. Therefore, the present study aimed to assess injury severity in the study population using the two tools and to use these to compare their predictive value for mortality and length of hospital stay.
2. Materials and Methods
2.1. Study Setting
The study was carried out in Mulago National Referral Hospital at the Accident and Emergency (A&E) unit, Intensive Care Unit, Neurosurgery Ward, and Neurosurgery Outpatients Department. The hospital is situated in Kampala, 2 kilometres from the city centre, and serves as Makerere University College of Health Sciences Teaching Hospital and as a National Referral Hospital for Uganda. The hospital has an official bed capacity of 1790 beds. The A&E unit comprises of a surgical casualty area, a casualty theatre, a radiology unit that provides x-ray and ultrasound scan services, emergency laboratory, a pharmacy, a plaster room, emergency surgical ward for admitted patients, and a trauma centre to cater for severely injured patients. The neurosurgery ward currently has a 40-bed capacity divided into 5 high dependency unit beds and 35 general ward beds. It has four neurosurgeons and 33 nursing staff. The Intensive Care Unit at Mulago Hospital currently has a 7-bed capacity with attending intensivists, anaesthesiologists, and senior house officers from different departments and 22 nursing staff.
2.2. Study Design and Procedure
This was a diagnostic prospective study. Head injury patients above 18 years admitted to the Accident and Emergency Unit in Mulago Hospital during the study period were solely eligible for recruitment. Patients who had head injury in addition to other injuries such as fractures of the femur, pelvis, haemoperitoneum, and haemothorax were excluded from the study. There was no restriction on patient inclusion in the study based on the time of injury and time of arrival to the hospital; however, those patients who had initial resuscitation in a different hospital before being referred to Mulago Hospital were not included in the study. Simple random sampling was performed to select the patients in the sampling frame with every second eligible participant considered therefore sampling at 50%. The data were collected every day of the week, 24 hours a day from January 12, 2018 to March 16, 2018. At admission, patients were screened for eligibility. Informed consent was sought at this point, and once this was obtained, a questionnaire was issued to the study participant. Admission time zero was marked on the questionnaire. This was defined as the time of initial interface between the clinician and the patient, and this was performed at the time of completion of the initial resuscitation. The admission time was used to establish the baseline GCS and KTS in the same patient that was to be compared to subsequent measurements; this was termed the admission GCS or KTS. The questionnaire was then filled. A second contact with the patient was at 24 hours following admission. Repeat measurements for the GCS and KTS were performed termed the GCS or KTS at 24 hours. The patients were followed up as they moved from the A&E unit either to the neurosurgery ward or the intensive care unit. The patients who were discharged before 14 days were followed through phone calls and reviewed in the neurosurgery out patients department to avoid loss to follow up and the outcome of interest determined. Final contact with the patient was at 14 days following admission. Whether the patient was alive or dead, their length of hospital stay, discharged home, transferred out, and if they are still in hospital 14 days post admission were assessed, and data were collected. The patients lost to follow up were subsequently excluded from the study. Figure 1 illustrates a flow chart to show how patients were recruited into the study and then followed up until the end of the study.
... The mortality predictive ability of KTS and RTS have been compared in various studies in many countries with different methodologies. Different results on the comparison of the KTS and RTS power in prediction of mortality has been reported in these studies (3,15,(17)(18)(19)(20)(21). In spite of the apparent lack of consistent results due to the heterogeneity among studies, a metaanalysis has not been yet performed. ...
Introduction
Describing injury severity in trauma patients is vital. In some recent articles the Revised Trauma Score (RTS) and Kampala Trauma Score (KTS) have been suggested as easily performed and feasible triage tools which can be used in resource-limited settings. The present meta-analysis was performed to evaluate and compare the accuracy of the RTS and KTS in predicting mortality in low-and middle income countries (LMICs).
Methods
Two investigators searched the Web of Science, Embase, and Medline databases and the articles which their exact number of true-positive, true-negative, false-positive, and false-negative results could be extracted were selected. Sensitivity and subgroup analysis were performed using Stata software version 14 to determine the factor(s) affecting the accuracy of the RTS and KTS in predicting mortality and source(s) of heterogeneity.
Results
The heterogeneity was high (I2 > 80%) among 11 relevant studies (total n = 20,631). While the sensitivity of the KTS (0.88) was slightly higher than RTS (0.82), the specificity, diagnostic odds ratio, negative likelihood ratio, and positive likelihood ratio of the KTS (0.73, 20, 0.16, 3.30, respectively) were lower than those of the RTS (0.91, 45, 0.20, 8.90, respectively). The area under the summary-receiver operator characteristic curve for KTS and RTS was 0.88 and 0.93, respectively.
Conclusion
However, regarding accuracy and performance, RTS was better than KTS for distinguishing between mortality and survival; both of them are beneficial trauma scoring tools which can be used in LMICs. Further studies are required to specify the appropriate choice of the RTS or KTS regarding the type of injury and different conditions of the patient.
... The KTS has previously been validated and found to compare favorably with other trauma scores [7,[23][24][25][26]. ...
Background:
Trauma is still the leading cause of death in many regions of the world. Severity scores have been developed to assist in management of trauma victims. Immune response to trauma has been known to positively correspond to the severity of trauma. Part of this response involves release of cytokines into blood circulation which promote the acute inflammatory response commonly seen after trauma. Studies have shown that IL-6 levels commonly correlate positively with the Injury Severity Score (ISS). The aim of this cross-sectional study was to determine whether this kind of relationship exists between IL-6 levels and injury severity in trauma patients in Mulago Hospital as defined by the Kampala Trauma Score (KTSII) which is locally developed.
Methods:
Trauma patients aged ≥18 years presenting to the Accident and Emergency unit of Mulago National Referral Hospital (MNRH) within 12 h after injury were recruited into the study after obtaining consent. Severity of injury was determined as per the Kampala Trauma Score (KTSII) and venous blood drawn for assay of serum IL-6 levels. Data obtained was entered and analyzed using Stata version 11 software focusing on the association between Serum IL-6 levels with Severity of trauma and duration of injury.
Results:
A total of 159 patients were recruited (79 Mild and 80 Severe trauma) with a male to female ratio of 4.7:1. Road traffic crashes (67.92 %) were the commonest cause of injury. Serum IL-6 levels were found to positively correspond with severity of injury (z = 4.718, p < 0.001). There was no significant correlation between serum IL-6 levels and duration of injury in both severe (r = 0.12, p = 0.29) and mild (r = 0.06, p = 0.62) trauma groups of patients. Only 9.43 % of trauma patients were brought in an Ambulance.
Conclusions:
Serum IL-6 levels correspond with severity of injury. However, within the first twelve hours after injury, these levels did not vary significantly with duration of injury.
... 19,20 En Colombia por ejemplo, desde hace unos años, solo un par de instituciones públicas, desarrollan esfuerzos para la implementación de registros de atención en trauma, a pesar de que en estas instituciones, se presta la cobertura a la mayoría de la población expuesta al trauma tanto a nivel rural como en las ciudades. [21][22][23] Por esta razón, se ha considerado de gran interés, el analizar estos datos de la experiencia del comité de análisis de casos de mortalidad por trauma en el HUN, uno de los centros que se encuentra actualmente desarrollando investigación en base a análisis de registros de atención de trauma en Colombia. Al comparar resultados con estudios realizados en otros países, 15-20 se encuentran similitudes, principalmente en las tasas de mortalidad prevenible y la asociación de estas con los tiempos de atención prolongados, la ausencia de apropiado cuidado prehospitalario, el mecanismo de lesión (penetrante) y los valores mayores de ISS. ...
Introduction: Mortality analysis meetings are a tool for the implementation of quality improvement programs in trauma care. This study aim is to analyze and characterize trauma deaths with an ISS greater than 16 in a university hospital in Colombia, after the implementation of a standardized trauma resuscitation protocol.
Materials and methods An analysis of trauma deaths with ISS equal or greater than 16 from September 2011 to April 2013 was performed. Measures of frequency, including ICD 10 diagnosis, type and mechanism of injury, hospital stay and hospital area of death, were analyzed. Deaths were analyzed and classified according to the WHO trauma quality improvement guidelines in categories of: preventable (PD), potentially preventable (PPD), not preventable but the management could be improved (NPDMI) and definitely not preventable (DNPD).
Results: Forty-two deaths occurred during this period. Predominantly adult male patients, in motor vehicle accidents involving motorcycles. The most common injury was severe brain injury (71.4%), followed by abdominal trauma (28.5%) and chest (26.1%) including closed and penetrating injuries. The average ISS was 37. The PD rate was 11.9%, PPD was 7.1%, the NPDMI was 14.2% and the DNPD was 66.6%.
Conclusion: After the implementation of a standardized trauma resuscitation protocol, in a Colombian university hospital, deaths with ISS equal or greater than 16 are mostly DNPD of adult patients with severe TBI and victims of motorcycle accident. The most common deficiency, in the NPDMI was the delay in the process of care, including an incomplete trauma protocol application and a non-early surgery.
Keywords:Quality Improvement, Trauma, Mortality analysis, Preventable deaths, Trauma quality
Tumors of the thyroid gland, due to their localization in the neck, can as they grow pose a threat to the airway.
Thyroid malignancies, aside from compression, can also infiltrate local tissue. The case presented is that of a
female patient with advanced thyroid cancer that required urgent airway management, but due to the
propagation of the malignancy into the mediastinum and consequent compression of distal trachea and lung
tissue, the hospitalization ended with a fatal outcome regardless of the treatment undertaken. Even advanced
airway management methods (endotracheal intubation or tracheotomy) are sometimes not enough to save our
patients' lives.
Background:
Globally, traumatic injury is a leading cause of morbidity and mortality in low-income countries. Current tools for predicting trauma-associated mortality are often not applicable in low-resource environments due to a lack of diagnostic adjuncts. This study sought to derive and validate a model for predicting mortality that requires only a history and physical exam.
Methods:
We conducted a retrospective analysis of all patients recorded in the Kamuzu Central Hospital trauma surveillance registry in Lilongwe, Malawi from 2011 through 2014. Using statistical randomization, 80% of patients were used for derivation and 20% were used for validation. Logistic regression modeling was used to derive factors associated with mortality and the Malawi Trauma Score (MTS) was constructed. The model fitness was tested.
Results:
62,354 patients are included. Patients are young (mean age 23.0, SD 15.9 years) with a male preponderance (72%). Overall mortality is 1.8%. The MTS is tabulated based on initial mental status (alert, responds to voice, responds only to pain or worse), anatomical location of the most severe injury, the presence or absence of a radial pulse on examination, age, and sex. The score range is 2-32. A mental status exam of only responding to pain or worse, head injury, the absence of a radial pulse, extremes of age, and male sex all conferred a higher probability of mortality. The ROC area under the curve for the derivation cohort and validation cohort were 0.83 (95% CI 0.78, 0.87) and 0.83 (95% CI 0.75, 0.92), respectively. A MTS of 25 confers a 50% probability of death.
Conclusions:
The MTS provides a reliable tool for trauma triage in sub-Saharan Africa and helps risk stratify patient populations. Unlike other models previously developed, its strength is its utility in virtually any environment, while reliably predicting injury- associated mortality.
The article provides an overview of methods for injury severity predicting which can be used for prehospital emergency medical service.
Methods:
Data were collected from the emergency departments of all public hospitals in the Northeast region of Haiti, which included the Fort Liberté, Ouanaminthe, and Trou du Nord sites. All patients presenting for emergent care of traumatic injuries were included. Data were obtained via review of emergency department registries and patient records from October 1, 2013 through November 30, 2013. Data on demographics, mechanisms of trauma, and anatomical regions of injury were gathered using a standardized tool and analyzed using descriptive statistics. Temporal analysis of injury frequency was explored using regression modeling.
Results:
Data from 383 patient encounters were accrued. Ouanaminthe Hospital treated the majority of emergent injuries (59.3%), followed by Fort Liberté (30.3%) and Trou du Nord (10.4%). The median age in years was 23 with 23.1% of patients being less than 15 years of age. Road traffic accidents (RTAs) and interpersonal violence accounted for 65.8% and 30.1% of all traumatic mechanisms, respectively. Extremity trauma was the most frequently observed anatomical region of injury (38.9%), followed by head and neck (30.3%) and facial (19.1%) injuries. Trauma due to RTA resulted in a single injury (83.8%) to either an extremity or the head and neck regions most frequently. A minority of patients had medical record documentation (37.9%). Blood pressure, respiratory rate, and mental status were documented in 19.3%, 4.1%, and 0.0% of records, respectively. There were 6.3 injuries/day during the data collection period with no correlation between the frequency of emergent trauma cases and day of the week (R^2=0.01).
Conclusions:
Traumatic injuries are a common emergent presentation in the Northeast region of Haiti with characteristics similar to other LMIC. Documentation and associated data to adequately characterize the burden of disease in this region are lacking. Road traffic accidents are the predominate mechanism of injury, suggesting that interventions addressing prevention and treatment of this common occurrence may provide public health benefits in this setting. Aluisio AR , De Wulf A , Louis A , Bloem C . Epidemiology of traumatic injuries in the Northeast region of Haiti: a cross-sectional study. Prehosp Disaster Med. 2015;30(6):1-7.
