A Comparison of the Kampala Trauma Score (KTS) with the Revised Trauma Score (RTS), Injury Severity Score (ISS) and the TRISS Method in a Ugandan Trauma Registry

Abstract

Background:The public health significance of injuries that occur in developing countries is now recognized. In 1996, as part of the injury surveillance registry in Kampala, Uganda, a new score, the Kampala Trauma Score (KTS) was instituted. The KTS, developed in light of the limited resource base of sub-Saharan Africa, is a simplified composite of the Revised Trauma Score (RTS) and the Injury Severity Score (ISS) and closely resembles the Trauma Score and Injury Severity Score (TRISS). Patients and Methods:The KTS was applied retrospectively to a cohort of prospectively accrued urban trauma patients with the RTS, ISS and TRISS calculated. Using ROC (receiver operating characteristics) analysis, logistic regression models and sensitivity and specificity cutoff analysis, the KTS was compared to these three scores. Results: Using logistic regression models and areas under the ROC curve, the RTS proved a more robust predictor of death at 2 weeks in comparison to the KTS. However, differences in screening performance were marginal (areas under the ROC curves were 87% for the RTS and 84% for the KTS) with statistical significance only reached for an improved specificity (67% vs. 47%; p < 0.001), at a fixed sensitivity of 90%. In addition, the KTS predicted hospitalization at 2 weeks more accurately. Conclusion:The KTS statistically performs comparably to the RTS and ISS alone as well as to the TRISS but has the added advantage of utility. Therefore, the KTS has potential as a triage tool in resource-poor and similar health care settings.

Choice of injury scoring system in low- and middle-income countries: Lessons from Mumbai

“…When stratifying MGAP scores as low (23)(24)(25)(26)(27)(28)(29), intermediate (18)(19)(20)(21)(22) and high (3-17) risk for death, the in-hospital mortality rates were uniformly higher than in the original validation cohort of the MGAP score in France (Table 3). The area under the ROC curve for the MGAP score in the French validation cohort was 0.90, compared with 0.85 in the subset of patients with sufficient data to Fig.…”

“…MGAP values ranged from 10 to 29, with a median value of 23 . GAP values ranged from 6 to 24, with a median value of 19 (IQR [14][15][16][17][18][19][20][21][22].…”

“…While ISS and RTS have been widely studied in high-income countries, none of these injury scoring systems have been rigorously validated in low-and middle-income countries [18,19]. There are substantial logistical demands associated with implementing the ISS, including detailed medical records, extensive radiographic studies and autopsy results, which are often unavailable in resource-poor settings [20].…”

Is the Kampala Trauma Score An Effective Predictor of Mortality in Low-Resource Settings? A Comparison of Multiple Trauma Severity Scores

“…This study reinforces their findings in a larger patient cohort of 2,855 patients, as the logistic regression model for mortality showed KTS to be a predictor of mortality, with adequate fit based on evaluation of goodness-of-fit using Akaike Information Criteria and Pearson's v 2 test. Furthermore, using the definition of severe injury employed by MacLeod et al [18], the Yaoundé study population yielded a sample of 244 patients to which to apply this methodology for subgroup analysis. Again, this study's findings confirm the performance of KTS as a scoring system for this subset of patients in a larger sample and a different study context, suggesting greater generalizability of KTS than the initial studies may have indicated.…”

Assessment of hospital-based adult triage at emergency receiving areas in hospitals in Northern Uganda

“…Whereas efforts have been made to introduce paediatric triage in Uganda such as Emergency Triage Assessment and Treatment Plus (ETAT+), the WHO tool and Integrated Management of Childhood Illness (IMCI) 9 , such programs are lacking for adult emergency medical care and it is not clear if hospitals have local protocols for adult triage. One triage score, the Kampala Trauma Score (KTS), was initially found to be a trauma triage tool for resource poor settings 10 . However, its usefulness was found to be limited 11 .…”