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Open Access

Thefeasibility, appropriateness, and applicability of trauma scoring systems in low and middle-income countries: a systematic review

Isabelle Feldhaus, Melissa Carvalho, Ghazel Waiz, Joel Igu, Zachary Matthay, Rochelle Dicker, Catherine Juillard
DOI: 10.1136/tsaco-2019-000424 Published 6 May 2020
Isabelle Feldhaus
1Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
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Melissa Carvalho
2Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
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Ghazel Waiz
3Department of Surgery, Center for Global Surgical Studies, University of California San Francisco, San Francisco, California, USA
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Joel Igu
4Johns Hopkins University Carey Business School, Baltimore, Maryland, USA
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Zachary Matthay
3Department of Surgery, Center for Global Surgical Studies, University of California San Francisco, San Francisco, California, USA
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Rochelle Dicker
2Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
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Catherine Juillard
2Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
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  • Figure 1
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    Figure 1

    Relational schema of existing trauma scoring systems. Boxes indicate a subset of standard trauma scoring systems reviewed here. Text outlines individual factors used to compute trauma score. Example: To compute AIS, injury severity is ranked by anatomic region. The computation of ISS is based on AIS assignment of each anatomic region. TRISS methodology incorporates ISS and RTS to predict probability of survival. AIS, Abbreviated Injury Scale; ASCOT, A Severity Characterization of Trauma; GCS, Glasgow Coma Scale; ISS, Injury Severity Score; KTS, Kampala Trauma Score; NISS, New Injury Severity Score; PHI, Prehospital Index; RTS, Revised Trauma Score; TRISS, Trauma and Injury Severity Score.

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    Figure 2

    Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram.

  • Figure 3
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    Figure 3

    Published studies reporting trauma scores in low and middle-income countries (LMIC) by year. AIS, Abbreviated Injury Scale; GCS, Glasgow Coma Scale; ISS, Injury Severity Score; KTS, Kampala Trauma Score; RTS, Revised Trauma Score; TRISS, Trauma and Injury Severity Score.

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    Figure 4

    Published studies reporting trauma scores in low and middle-income countries (LMIC) by WHO region. AIS, Abbreviated Injury Scale; GCS, Glasgow Coma Scale; ISS, Injury Severity Score; KTS, Kampala Trauma Score; RTS, Revised Trauma Score; TRISS, Trauma and Injury Severity Score.

Tables

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  • Table 1

    Reported feasibility of trauma scoring systems

    Trauma scoreOpportunitiesConstraintsReferences
    Good clinical assessmentTriage toolSufficient dataLack of equipmentLack of human resourcesInsufficient/poor-quality dataInappropriate for populationUsed modified version
    ISS✓✓✓✓✓ (eISS)7 31 32 73 75 77 90 102 103 112–114
    AIS✓✓75 102 115
    RTS✓✓12 79 103 116
    KTS✓✓✓12 15 73 82
    TRISS✓✓✓✓✓27 28 34 73 75 93 95 106 107
    • AIS, Abbreviated Injury Scale; eISS, estimated ISS; ISS, Injury Severity Score; KTS, Kampala Trauma Score; RTS, Revised Trauma Score; TRISS, Trauma and Injury Severity Score.

  • Table 2

    Additional reported correlates of trauma scores

    Trauma scorePositive correlates
    ISSIncidence of organ dysfunction
    Length of stay/prolonged or continued hospitalization
    Morbidity
    Postoperative complications
    Severity/grades of anatomic-specific injuries
    AISHospital admission
    Long-term functional outcomes
    Severity/grades of anatomic-specific injuries
    RTSHospital admission
    Length of stay/prolonged or continued hospitalization
    Morbidity
    Nosocomial infections
    Postoperative complications
    KTSHospital admission*
    Length of stay/prolonged or continued hospitalization†
    Prehospital transportation
    TRISSLength of stay/prolonged or continued hospitalization
    Nosocomial infections
    • *Three studies reported KTS was a significant predictor of need for admission13 15 79; one study reported KTS was poor in predicting need for admission.86

    • †Three studies reported KTS predicted longer hospitalization70 117; one study reported KTS was not a good indicator of prolonged hospitalization.79

    • AIS, Abbreviated Injury Scale; ISS, Injury Severity Score; KTS, Kampala Trauma Score; RTS, Revised Trauma Score; TRISS, Trauma and Injury Severity Score.

Supplementary Materials

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    [tsaco-2019-000424supp001.pdf]

  • Supplementary data

    [tsaco-2019-000424supp002.pdf]

  • Supplementary data

    [tsaco-2019-000424supp003.pdf]

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Thefeasibility, appropriateness, and applicability of trauma scoring systems in low and middle-income countries: a systematic review
Isabelle Feldhaus, Melissa Carvalho, Ghazel Waiz, Joel Igu, Zachary Matthay, Rochelle Dicker, Catherine Juillard
Trauma Surg Acute Care Open May 2020, 5 (1) e000424; DOI: 10.1136/tsaco-2019-000424

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Thefeasibility, appropriateness, and applicability of trauma scoring systems in low and middle-income countries: a systematic review
Isabelle Feldhaus, Melissa Carvalho, Ghazel Waiz, Joel Igu, Zachary Matthay, Rochelle Dicker, Catherine Juillard
Trauma Surg Acute Care Open May 2020, 5 (1) e000424; DOI: 10.1136/tsaco-2019-000424
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Thefeasibility, appropriateness, and applicability of trauma scoring systems in low and middle-income countries: a systematic review
Isabelle Feldhaus, Melissa Carvalho, Ghazel Waiz, Joel Igu, Zachary Matthay, Rochelle Dicker, Catherine Juillard
Trauma Surgery & Acute Care Open May 2020, 5 (1) e000424; DOI: 10.1136/tsaco-2019-000424
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