A Comparison of Kampala Trauma Score II with the New Injury Severity Score in Mbarara University Teaching Hospital in Uganda
Background: Road traffic injury is of growing public health importance because of its significant contribution to the global disease burden. The need to predict outcome of injuries has led to the development of injury scores. The Kampala Trauma Score II (KTSII) now recommended for use in resource-poor settings, has not been compared with, the New Injury Severity Score (NISS) preferred by many authors. We compared the performance, predictive power, sensitivity, and specificity in predicting mortality at two weeks of the KTSII and NISS in patients involved in road traffic accidents seen on the surgical ward at Mbarara Regional Referral Hospital (MRRH).
Methods: This prospective study conducted between June 2005 and August 2006, examined clinical and radiological data of 173 consecutive patients admitted to the emergency surgical ward at Mbarara Regional Referral Hospital with road traffic injuries. Only patients presenting within 24 hours of injury and with 3 or more injuries were recruited in the study. The KTS II and NISS scores were computed for each patient on admission. The primary outcome measure was survival. Receiver Operating Characteristics (ROC) analysis, and logistic regression analysis were used for comparison.
Results: The KTSII predicted mortality and discharge with AUC of 0.87 (NISS, AUC 0.89). The KTSII was less accurate (AUC 0.65) than the NISS (AUC 0.83) in predicting long stay in the hospital. At cut off point of 9 and below, the KTSII had sensitivity of 87% and specificity of 81% while the NISS had 96% and 78.4% respectively in predicting mortality. The KTS II predicted long hospital stay at cut off score of 9 and below, with sensitivity of 87.5% and specificity of 81%.
Conclusions: The KTSII is as reliable a predictive score as is the NISS. This study demonstrated that the KTS II provides reliable objective criterion upon which injured patients can be triaged in emergency care conditions. The KTS II may enhance the use of ambulance services and timely transfer of the injured and its use in trauma management should be further encouraged in resource-poor settings. In addition, the KTS II will make the documentation of the epidemiology of trauma more feasible in resource-poor settings.