Validation of international trauma scoring systems in urban trauma centres in India

Nobhojit Roy, Martin Gerdin, Eric Schneider, Deepa K. Kizhakke Veetil, Monty Khajanchi, Vineet Kumar, Makhal Lal Saha, Satish Dharap, Amit Gupta, Göran Tomson, Johan von Schreeb

Research output: Contribution to journalArticle

Abstract

Introduction In the Lower-Middle Income Country setting, we validate trauma severity scoring systems, namely Injury Severity Score (ISS), New Injury Severity Scale (NISS) score, the Kampala Trauma Score (KTS), Revised Trauma Score (RTS) score and the TRauma Injury Severity Score (TRISS) using Indian trauma patients. Patients and methods From 1 September 2013 to 28 February 2015, we conducted a prospective multi-centre observational cohort study of trauma patients in four Indian university hospitals, in three megacities, Kolkata, Mumbai and Delhi. All adult patients presenting to the casualty department with a history of injury and who were admitted to inpatient care were included. The primary outcome was in-hospital mortality within 30-days of admission. The sensitivity and specificity of each score to predict inpatient mortality within 30 days was assessed by the areas under the receiver operating characteristic curve (AUC). Model fit for the performance of individual scoring systems was accomplished by using the Akaike Information criterion (AIC). Results In a registry of 8791 adult trauma patients, we had a cohort of 7197 patients eligible for the study. 4091 (56.8%)patients had all five scores available and was the sample for a complete case analysis. Over a 30-day period, the scores (AUC) was TRISS (0.82), RTS (0.81), KTS (0.74), NISS (0.65) and ISS (0.62). RTS was the most parsimonious model with the lowest AIC score. Considering overall mortality, both physiologic scores (RTS, KTS) had better discrimination and goodness-of-fit than ISS or NISS. The ability of all Injury scores to predict early mortality (24 h) was better than late mortality (30 day). Conclusion On-admission physiological scores outperformed the more expensive anatomy-based ISS and NISS. The retrospective nature of ISS and TRISS score calculations and incomplete imaging in LMICs precludes its use in the casualty department of LMICs. They will remain useful for outcome comparison across trauma centres. Physiological scores like the RTS and KTS will be the practical score to use in casualty departments in the urban Indian setting, to predict early trauma mortality and improve triage.

Original languageEnglish (US)
Pages (from-to)2459-2464
Number of pages6
JournalInjury
Volume47
Issue number11
DOIs
StatePublished - Nov 1 2016
Externally publishedYes

Fingerprint

Trauma Centers
India
Wounds and Injuries
Injury Severity Score
Mortality
Area Under Curve
Inpatients

Keywords

  • India
  • Injury
  • Injury scoring system
  • ISS
  • KTS
  • NISS
  • RTS
  • Trauma
  • TRISS
  • Urban

ASJC Scopus subject areas

  • Emergency Medicine
  • Orthopedics and Sports Medicine

Cite this

Roy, N., Gerdin, M., Schneider, E., Kizhakke Veetil, D. K., Khajanchi, M., Kumar, V., ... von Schreeb, J. (2016). Validation of international trauma scoring systems in urban trauma centres in India. Injury, 47(11), 2459-2464. https://doi.org/10.1016/j.injury.2016.09.027

Validation of international trauma scoring systems in urban trauma centres in India. / Roy, Nobhojit; Gerdin, Martin; Schneider, Eric; Kizhakke Veetil, Deepa K.; Khajanchi, Monty; Kumar, Vineet; Saha, Makhal Lal; Dharap, Satish; Gupta, Amit; Tomson, Göran; von Schreeb, Johan.

In: Injury, Vol. 47, No. 11, 01.11.2016, p. 2459-2464.

Research output: Contribution to journalArticle

Roy, N, Gerdin, M, Schneider, E, Kizhakke Veetil, DK, Khajanchi, M, Kumar, V, Saha, ML, Dharap, S, Gupta, A, Tomson, G & von Schreeb, J 2016, 'Validation of international trauma scoring systems in urban trauma centres in India', Injury, vol. 47, no. 11, pp. 2459-2464. https://doi.org/10.1016/j.injury.2016.09.027
Roy N, Gerdin M, Schneider E, Kizhakke Veetil DK, Khajanchi M, Kumar V et al. Validation of international trauma scoring systems in urban trauma centres in India. Injury. 2016 Nov 1;47(11):2459-2464. https://doi.org/10.1016/j.injury.2016.09.027
Roy, Nobhojit ; Gerdin, Martin ; Schneider, Eric ; Kizhakke Veetil, Deepa K. ; Khajanchi, Monty ; Kumar, Vineet ; Saha, Makhal Lal ; Dharap, Satish ; Gupta, Amit ; Tomson, Göran ; von Schreeb, Johan. / Validation of international trauma scoring systems in urban trauma centres in India. In: Injury. 2016 ; Vol. 47, No. 11. pp. 2459-2464.
@article{5d69482e8df44fab860531965a429f44,
title = "Validation of international trauma scoring systems in urban trauma centres in India",
abstract = "Introduction In the Lower-Middle Income Country setting, we validate trauma severity scoring systems, namely Injury Severity Score (ISS), New Injury Severity Scale (NISS) score, the Kampala Trauma Score (KTS), Revised Trauma Score (RTS) score and the TRauma Injury Severity Score (TRISS) using Indian trauma patients. Patients and methods From 1 September 2013 to 28 February 2015, we conducted a prospective multi-centre observational cohort study of trauma patients in four Indian university hospitals, in three megacities, Kolkata, Mumbai and Delhi. All adult patients presenting to the casualty department with a history of injury and who were admitted to inpatient care were included. The primary outcome was in-hospital mortality within 30-days of admission. The sensitivity and specificity of each score to predict inpatient mortality within 30 days was assessed by the areas under the receiver operating characteristic curve (AUC). Model fit for the performance of individual scoring systems was accomplished by using the Akaike Information criterion (AIC). Results In a registry of 8791 adult trauma patients, we had a cohort of 7197 patients eligible for the study. 4091 (56.8{\%})patients had all five scores available and was the sample for a complete case analysis. Over a 30-day period, the scores (AUC) was TRISS (0.82), RTS (0.81), KTS (0.74), NISS (0.65) and ISS (0.62). RTS was the most parsimonious model with the lowest AIC score. Considering overall mortality, both physiologic scores (RTS, KTS) had better discrimination and goodness-of-fit than ISS or NISS. The ability of all Injury scores to predict early mortality (24 h) was better than late mortality (30 day). Conclusion On-admission physiological scores outperformed the more expensive anatomy-based ISS and NISS. The retrospective nature of ISS and TRISS score calculations and incomplete imaging in LMICs precludes its use in the casualty department of LMICs. They will remain useful for outcome comparison across trauma centres. Physiological scores like the RTS and KTS will be the practical score to use in casualty departments in the urban Indian setting, to predict early trauma mortality and improve triage.",
keywords = "India, Injury, Injury scoring system, ISS, KTS, NISS, RTS, Trauma, TRISS, Urban",
author = "Nobhojit Roy and Martin Gerdin and Eric Schneider and {Kizhakke Veetil}, {Deepa K.} and Monty Khajanchi and Vineet Kumar and Saha, {Makhal Lal} and Satish Dharap and Amit Gupta and G{\"o}ran Tomson and {von Schreeb}, Johan",
year = "2016",
month = "11",
day = "1",
doi = "10.1016/j.injury.2016.09.027",
language = "English (US)",
volume = "47",
pages = "2459--2464",
journal = "Injury",
issn = "0020-1383",
publisher = "Elsevier Limited",
number = "11",

}

TY - JOUR

T1 - Validation of international trauma scoring systems in urban trauma centres in India

AU - Roy, Nobhojit

AU - Gerdin, Martin

AU - Schneider, Eric

AU - Kizhakke Veetil, Deepa K.

AU - Khajanchi, Monty

AU - Kumar, Vineet

AU - Saha, Makhal Lal

AU - Dharap, Satish

AU - Gupta, Amit

AU - Tomson, Göran

AU - von Schreeb, Johan

PY - 2016/11/1

Y1 - 2016/11/1

N2 - Introduction In the Lower-Middle Income Country setting, we validate trauma severity scoring systems, namely Injury Severity Score (ISS), New Injury Severity Scale (NISS) score, the Kampala Trauma Score (KTS), Revised Trauma Score (RTS) score and the TRauma Injury Severity Score (TRISS) using Indian trauma patients. Patients and methods From 1 September 2013 to 28 February 2015, we conducted a prospective multi-centre observational cohort study of trauma patients in four Indian university hospitals, in three megacities, Kolkata, Mumbai and Delhi. All adult patients presenting to the casualty department with a history of injury and who were admitted to inpatient care were included. The primary outcome was in-hospital mortality within 30-days of admission. The sensitivity and specificity of each score to predict inpatient mortality within 30 days was assessed by the areas under the receiver operating characteristic curve (AUC). Model fit for the performance of individual scoring systems was accomplished by using the Akaike Information criterion (AIC). Results In a registry of 8791 adult trauma patients, we had a cohort of 7197 patients eligible for the study. 4091 (56.8%)patients had all five scores available and was the sample for a complete case analysis. Over a 30-day period, the scores (AUC) was TRISS (0.82), RTS (0.81), KTS (0.74), NISS (0.65) and ISS (0.62). RTS was the most parsimonious model with the lowest AIC score. Considering overall mortality, both physiologic scores (RTS, KTS) had better discrimination and goodness-of-fit than ISS or NISS. The ability of all Injury scores to predict early mortality (24 h) was better than late mortality (30 day). Conclusion On-admission physiological scores outperformed the more expensive anatomy-based ISS and NISS. The retrospective nature of ISS and TRISS score calculations and incomplete imaging in LMICs precludes its use in the casualty department of LMICs. They will remain useful for outcome comparison across trauma centres. Physiological scores like the RTS and KTS will be the practical score to use in casualty departments in the urban Indian setting, to predict early trauma mortality and improve triage.

AB - Introduction In the Lower-Middle Income Country setting, we validate trauma severity scoring systems, namely Injury Severity Score (ISS), New Injury Severity Scale (NISS) score, the Kampala Trauma Score (KTS), Revised Trauma Score (RTS) score and the TRauma Injury Severity Score (TRISS) using Indian trauma patients. Patients and methods From 1 September 2013 to 28 February 2015, we conducted a prospective multi-centre observational cohort study of trauma patients in four Indian university hospitals, in three megacities, Kolkata, Mumbai and Delhi. All adult patients presenting to the casualty department with a history of injury and who were admitted to inpatient care were included. The primary outcome was in-hospital mortality within 30-days of admission. The sensitivity and specificity of each score to predict inpatient mortality within 30 days was assessed by the areas under the receiver operating characteristic curve (AUC). Model fit for the performance of individual scoring systems was accomplished by using the Akaike Information criterion (AIC). Results In a registry of 8791 adult trauma patients, we had a cohort of 7197 patients eligible for the study. 4091 (56.8%)patients had all five scores available and was the sample for a complete case analysis. Over a 30-day period, the scores (AUC) was TRISS (0.82), RTS (0.81), KTS (0.74), NISS (0.65) and ISS (0.62). RTS was the most parsimonious model with the lowest AIC score. Considering overall mortality, both physiologic scores (RTS, KTS) had better discrimination and goodness-of-fit than ISS or NISS. The ability of all Injury scores to predict early mortality (24 h) was better than late mortality (30 day). Conclusion On-admission physiological scores outperformed the more expensive anatomy-based ISS and NISS. The retrospective nature of ISS and TRISS score calculations and incomplete imaging in LMICs precludes its use in the casualty department of LMICs. They will remain useful for outcome comparison across trauma centres. Physiological scores like the RTS and KTS will be the practical score to use in casualty departments in the urban Indian setting, to predict early trauma mortality and improve triage.

KW - India

KW - Injury

KW - Injury scoring system

KW - ISS

KW - KTS

KW - NISS

KW - RTS

KW - Trauma

KW - TRISS

KW - Urban

UR - http://www.scopus.com/inward/record.url?scp=84994157560&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84994157560&partnerID=8YFLogxK

U2 - 10.1016/j.injury.2016.09.027

DO - 10.1016/j.injury.2016.09.027

M3 - Article

C2 - 27667119

AN - SCOPUS:84994157560

VL - 47

SP - 2459

EP - 2464

JO - Injury

JF - Injury

SN - 0020-1383

IS - 11

ER -