The Pattern and Outcome of Severe Trauma Using the Trauma and Injury Severity Score (TRISS) Methodology in a Dedicated Trauma Centre in Nigeria

Abstract

Background: Trauma is a leading cause of mortality and a major contributor of disability as measured by Disability Adjusted Life years lost to inury in various parts of the world. Pattern of injuries and quality of care given to trauma patients differ in various parts of the world. The quality of care given in a particular centre can be assessed and compared with that from other centres by utilising an established standard method of assessment such as the Trauma Research and Injury Severity Score (TRISS). In this observational study, the pattern of presentation of severe trauma and quality of care given to severely injured patients at a trauma centre in Nigeria is evaluated using the TRISS methodology. The findings are compared with those reported from other countries. Methods: Data required for trauma demographics and TRISS calculation was extracted from the trauma registry of Teme Hospital, Port Harcourt Nigeria and analysed. Trauma demographics, type of care and the probability of survival of included patients were evaluated using the TRISS methodology. Results: Seven hundred and sixty two patients were seen with severe trauma but 746 patients had enough information required for analysis. Most of the trauma patients seen at the centre were males with a mean age ± standard deviation of 28.5 ± 11.3 years. Road traffic collision was the commonest cause of injury (41.2%) but gunshot injuries contributed a sizable number of the injuries (36.7%). The median Injury Severity Score (ISS) was 20 (range = 16 – 75) while the mean Revised Trauma Score (RTS) ± SD was 7.1 ± 1.3. The median probability of survival was 0.98 with a range between 0.00 and 0.99. The M, Z, and W statistics were 0.87, - 8.5, and -7.0 respectively. From TRISS analysis, 38 patients (5.1%) were expected to die but the observed mortality was 12.4%. Most mortality was related to severe head injuries. Conclusion: Trauma burden is an identified problem at Teme Hospital Nigeria. Severe trauma constitutes only 12% of trauma cases seen at the centre but it is the main contributor to trauma deaths. The observed mortality is higher than the expected as calculated using TRISS methodology and this call for improvement in the quality of care at the centre.