Predicting mortality in severe polytrauma with limited resources

Abstract

BACKGROUND: Objective evaluation of the severity of injured patients is crucial for the adequate triage, decision-making, op- erative and intensive care management, prevention, outcome studies, and system quality assessment. This study aimed to compare six, widely-used, trauma scores as predictors of mortality, and to identify the most powerful among them in limited-resources settin. METHODS: Seventy-five polytraumatized patients, admitted to the Intensive care unit (ICU) of the Clinic for Emergency Surgery (Level 1 trauma center, CSS Belgrade) from June 2018 to August 2020, were included in the study. The inclusion criteria were age ≥16, Injury Severity Score (ISS) ≥16, and Sequential Organ Failure Assessment (SOFA) ≥5 points. Scores were evaluated using logistic regression model and analysis of areas under the receiver operating characteristic curve (AUC). RESULTS: During the 26 months period, highly selected cases, mostly of blunt trauma (97.3%), due to a road traffic accident (68%) and free-falls (25.3%), were included in the study. Surgery was indicated in 56 (74.7%) and non-operative treatment in 19 (25.3%) cases, with overall mortality rate at 36%. Logistic regression analysis demonstrated that all six trauma scores (ISS, NISS, Acute Physiologic Assessment and Chronic Health Evaluation [APACHE 2], SOFA, Trauma ISS [TRISS], and Kampala Trauma Score [KTS]) were signif- icant mortality predictors (p