Background
The Kampala Trauma Score (KTS) has been proposed as a triage tool for use in low- and middle-income countries (LMICs). This study aimed to examine the diagnostic accuracy of KTS in predicting emergency department outcomes using timely injury estimation with Abbreviated Injury Scale (AIS) score and physician opinion to calculate KTS scores.
Methods
This was a diagnostic accuracy study of KTS among injured patients presenting to Komfo Anokye Teaching Hospital A&E, Ghana. South African Triage Scale (SATS); KTS component variables, including AIS scores and physician opinion for serious injury quantification; and ED disposition were collected. Agreement between estimated AIS score and physician opinion were analyzed with normal, linear weighted, and maximum kappa. Receiver operating characteristic (ROC) analysis of KTS-AIS and KTS-physician opinion was performed to evaluate each measure’s ability to predict A&E mortality and need for hospital admission to the ward or theatre.
Results
A total of 1,053 patients were sampled. There was moderate agreement between AIS criteria and physician opinion by normal (κ=0.41), weighted (κlin=0.47), and maximum (κmax=0.53) kappa. A&E mortality ROC area for KTS-AIS was 0.93, KTS-physician opinion 0.89, and SATS 0.88 with overlapping 95% confidence intervals (95%CI). Hospital admission ROC area for KTS-AIS was 0.73, KTS-physician opinion 0.79, and SATS 0.71 with statistical similarity. When evaluating only patients with serious injuries, KTS-AIS (ROC 0.88) and KTS-physician opinion (ROC 0.88) performed similarly to SATS (ROC 0.78) in predicting A&E mortality. The ROC area for KTS-AIS (ROC 0.71; 95%CI 0.66–0.75) and KTS-physician opinion (ROC 0.74; 95%CI 0.69–0.79) was significantly greater than SATS (ROC 0.57; 0.53–0.60) with regard to need for admission.
Conclusions
KTS predicted mortality and need for admission from the ED well when early estimation of the number of serious injuries was used, regardless of method (i.e. AIS criteria or physician opinion). This study provides evidence for KTS to be used as a practical and valid triage tool to predict patient prognosis, ED outcomes and inform referral decision-making from first- or second-level hospitals in LMICs.
While TEG variables more closely predicted circuit longevity than conventional coagulation variables, the clinical benefit of TEG monitoring of anticoagulation for CRRT would appear to be minimal.
Gastric perforation in association with incarceration of a hiatus hernia rarely features on a list of differential diagnoses of acute chest pain. A patient presented to the emergency department with acute chest pain characteristic of myocardial ischaemia. Several risk factors for ischaemic heart disease (IHD) were present. Investigations revealed normal cardiac enzymes and normal electrocardiography both initially and at 90 mins. A chest radiograph demonstrated the presence of a hiatus hernia. The patient was diagnosed with, and treated for, unstable angina. A troponin T test at 12 h post-admission was normal. The patient's clinical condition continued to deteriorate. The source of her pain was found to be gastric perforations in association with an incarcerated hiatus hernia. Her postoperative course was complicated by pulmonary and intra-abdominal sepsis necessitating admission to the intensive care unit where she remained for 23 days. This case highlights the challenge that non-cardiac chest pain presents to the acute care physician. Patients who present with risk factors for and symptoms consistent with a diagnosis of IHD may have non-cardiogenic pathology which can be life-threatening.
Study/Objective: To determine the diagnostic accuracy of the Kampala Trauma Score in predicting Emergency Department outcomes in a limited diagnostics setting. Background: The Kampala Trauma Score (KTS) has been proposed as a triage tool for use in low-and middle-income countries (LMICs). This study aimed to examine the diagnostic accuracy of KTS in predicting emergency department (ED) outcomes, using timely injury estimation with Abbreviated Injury Scale (AIS) score, and physician opinion (PO). Methods: This was a diagnostic accuracy study of KTS among injured patients presenting to Komfo Anokye Teaching Hospital, Ghana. The South African Triage Scale (SATS), KTS and Revised Trauma Score (RTS) variables, PO quantifying serious injuries, and ED disposition were collected. Agreement between estimated AIS score and PO were analyzed with normal, linear weighted, and maximum kappa. Additionally, receiver operating characteristic (ROC) analysis of KTS-AIS and KTS-PO was performed. Results: A total of 1,053 patients were sampled. There was moderate agreement between AIS criteria and PO by normal Conclusion: KTS predicted mortality and need for admission from the ED very well when early estimation of the number of serious injuries was used, regardless of method (ie, AIS criteria or physician opinion). This study provides evidence for KTS to be used as a practical and valid triage tool to predict prognosis, ED outcomes, and inform referral decision making from first-or second-level hospitals in LMICs.
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