Performance of Prognostication Scores for Mortality in Injured Patients in Rwanda.
Performance of Prognostication Scores for Mortality in Injured Patients in Rwanda.
复制标题
卢旺达受伤患者死亡率预测评分的表现。
DOI：
10.5811/westjem.2020.10.48434
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发表时间：
2021-01-22
期刊：
影响因子：
--
通讯作者：
Aluisio AR
中科院分区：
文献类型：
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作者：
Tang OY;Marqués CG;Ndebwanimana V;Uwamahoro C;Uwamahoro D;Lipsman ZW;Naganathan S;Karim N;Nkeshimana M;Levine AC;Stephen A;Aluisio AR
虽然创伤预测和分诊评分是专门为资源较少的医疗保健环境而设计的，但在这种情况下，针对风险分层的受伤患者的创伤特定分诊评分和一般分诊评分之间的临床表现的比较尚不清楚。这项研究评估了坎帕拉创伤评分(KTS)、修订创伤评分(RTS)和分诊预警评分(TEWS)在卢旺达基加利大学医院(CHUK)急诊科(ED)就诊的受伤患者中预测死亡率的准确性。对2015年8月至2016年7月期间出现损伤的ED患者进行了随机抽样的回顾性队列研究。主要结果是14天的死亡率，次要结果是基于设施的总死亡率。我们评估了队列的汇总统计数据。用Bootstrap回归模型比较受试者工作曲线(AUC)下的面积与相关的95%可信区间(CI)。617例中，中位年龄32岁，男性占73.5%。最常见的伤害机制是道路交通事故(56.2%)。损伤解剖部位以颅面(39.3%)和肢体(38.7%)为主，最常见的损伤类型为骨折(46.0%)和挫伤(12.0%)。14天死亡率为2.6%，基于设施的总死亡率为3.4%。对于14d死亡率，TEWS的准确率最高(AUC=0.88，95%CI，0.76~1.00)，其次是RTS(AUC=0.73，95%CI，0.55~0.92)，KTS次之(AUC=0.65，95%CI，0.47~0.84)。同样，对于基于设施的死亡率，TEWS(AUC=0.89，95%CI，0.79~0.98)比RTS(AUC=0.76，95%CI，0.61~0.91)和KTS(AUC=0.68，95%CI，0.53~0.83)具有更高的准确性。在两两比较中，RTS对14天死亡率的预测准确性高于KTS(P=0.011)，而TEWS对总死亡率的预测准确性高于KTS(P=0.007)。然而，对于14天的死亡率(P=0.864)或基于设施的死亡率(P=0.101)，TEWS和RTS的准确性没有显著差异。在卢旺达的这组急诊受伤患者中，TEWS显示了预测死亡结果的最高准确性，在使用创伤专用RTS或KTS工具时没有发现显著的歧视性益处，这表明在所研究的环境中，TEWS是最有临床实用价值的方法，可能在其他类似的ED环境中也是如此。
While trauma prognostication and triage scores have been designed for use in lower-resourced healthcare settings specifically, the comparative clinical performance between trauma-specific and general triage scores for risk-stratifying injured patients in such settings is not well understood. This study evaluated the Kampala Trauma Score (KTS), Revised Trauma Score (RTS), and Triage Early Warning Score (TEWS) for accuracy in predicting mortality among injured patients seeking emergency department (ED) care at the Centre Hospitalier Universitaire de Kigali (CHUK) in Rwanda. A retrospective, randomly sampled cohort of ED patients presenting with injury was accrued from August 2015–July 2016. Primary outcome was 14-day mortality and secondary outcome was overall facility-based mortality. We evaluated summary statistics of the cohort. Bootstrap regression models were used to compare areas under receiver operating curves (AUC) with associated 95% confidence intervals (CI). Among 617 cases, the median age was 32 years and 73.5% were male. The most frequent mechanism of injury was road traffic incident (56.2%). Predominant anatomical regions of injury were craniofacial (39.3%) and lower extremities (38.7%), and the most common injury types were fracture (46.0%) and contusion (12.0%). Fourteen-day mortality was 2.6% and overall facility-based mortality was 3.4%. For 14-day mortality, TEWS had the highest accuracy (AUC = 0.88, 95% CI, 0.76–1.00), followed by RTS (AUC = 0.73, 95% CI, 0.55–0.92), and then KTS (AUC = 0.65, 95% CI, 0.47–0.84). Similarly, for facility-based mortality, TEWS (AUC = 0.89, 95% CI, 0.79–0.98) had greater accuracy than RTS (AUC = 0.76, 95% CI, 0.61–0.91) and KTS (AUC = 0.68, 95% CI, 0.53–0.83). On pairwise comparisons, RTS had greater prognostic accuracy than KTS for 14-day mortality (P = 0.011) and TEWS had greater accuracy than KTS for overall (P = 0.007) mortality. However, TEWS and RTS accuracy were not significantly different for 14-day mortality (P = 0.864) or facility-based mortality (P = 0.101). In this cohort of emergently injured patients in Rwanda, the TEWS demonstrated the greatest accuracy for predicting mortality outcomes, with no significant discriminatory benefit found in the use of the trauma-specific RTS or KTS instruments, suggesting that the TEWS is the most clinically useful approach in the setting studied and likely in other similar ED environments.
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影响因子：
8.1
作者：
Dalwai, Mohammed;Valles, Pola;Tayler-Smith, Katie
通讯作者：
Tayler-Smith, Katie
DOI：
10.1097/00005373-200003000-00022
发表时间：
2000-03-01
影响因子：
--
作者：
Kobusingye, OC;Lett, RR
通讯作者：
Lett, RR
影响因子：
3.2
作者：
Hanewinckel, Rens;Jongman, Henri P.;Mulligan, Terrence M.
通讯作者：
Mulligan, Terrence M.
影响因子：
1.3
作者：
Aluisio, Adam R.;Barry, Meagan A.;Levine, Adam C.
通讯作者：
Levine, Adam C.
影响因子：
--
作者：
BLAND, JM;ALTMAN, DG
通讯作者：
ALTMAN, DG