Oliver Y Tang1, Catalina González Marqués2, Vincent Ndebwanimana3,4, Chantal Uwamahoro3,4, Doris Uwamahoro3,4, Zachary W Lipsman5, Sonya Naganathan2, Naz Karim2, Menelas Nkeshimana3,4, Adam C Levine2, Andrew Stephen6, Adam R Aluisio2. 1. Brown University Warren Alpert Medical School, Department, Providence, Rhode Island. 2. Brown University Warren Alpert Medical School, Department of Emergency Medicine, Providence, Rhode Island. 3. University of Rwanda, Department of Anesthesia, Emergency Medicine, and Critical Care, Kigali, Rwanda. 4. Centre Hospitalier Universitaire de Kigali, Department of Accident & Emergency, Kigali, Rwanda. 5. Kaiser Permanente, GSAA, San Leandro & Fremont Medical Centers, San Leandro, California. 6. Brown University Warren Alpert Medical School, Department of Surgery, Providence, Rhode Island.
Abstract
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.
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.
Authors: Andrew Gardner; Paa Kobina Forson; George Oduro; Barclay Stewart; Nkechi Dike; Paul Glover; Ronald F Maio Journal: Injury Date: 2016-11-21 Impact factor: 2.586
Authors: Adam R Aluisio; Olivier Félix Umuhire; Gabin Mbanjumucyo; Naomi George; Alexis Kearney; Naz Karim; Jeanne DʼArc Nyinawankusi; Eric Uwitonze; Sam Enumah; John W Scott; Zeta Mutabazi; Georges Ntakiyiruta; Sudha Jayaraman; Robert Riviello; Jean Claude Byiringiro; Adam C Levine Journal: Pediatr Emerg Care Date: 2019-09 Impact factor: 1.454
Authors: Chantal Uwamahoro; Adam R Aluisio; Esther Chu; Ellen Reibling; Zeta Mutabazi; Naz Karim; Jean Claude Byiringiro; Adam C Levine; Mindi Guptill Journal: Afr J Emerg Med Date: 2019-11-18
Authors: Aly Beeman; Catalina Gonzalez Marques; Oliver Y Tang; Chantal Uwamahoro; Spandana Jarmale; Zeta Mutabazi; Vincent Ndebwanimana; Doris Uwamahoro; Mediatrice Niyonsaba; Andrew Stephen; Adam R Aluisio Journal: Afr J Emerg Med Date: 2022-06-24