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Paediatric Injury Scoring and Trauma Registry 169
Table 26.10: Examples of how to calculate some trauma scores for many and include the provision of data for injury surveillance, analysis,
hypothetical scenarios. and prevention programmes; monitoring and evaluation of the outcome
of care of trauma patients; support of quality assurance evaluation activi-
Abbreviated Injury Score (AIS)
ties; provision of information for resource planning, system design, and
Head/Neck Subdural haematoma AIS score = 4 management; provision of resources for research and education; and
validation and evolution of scoring systems for improved management
Face Abrasions AIS score = 1 of trauma patients. The successful implementation of trauma care sys-
tems, including their quality assurance through trauma registries, has
Chest Fracture of four ribs AIS score = 4
contributed to the decline in death and disability resulting from injuries.
This is evidenced by a decline in projected road traffic deaths in high-
Abdomen Splenic laceration (Grade IV) AIS score = 4
income countries, whereas those in middle- to low-income countries
continue to rise. 21,22 Improvement in trauma care in Africa will rely on
Extremity Fracture right femur AIS score = 3
further development of functioning prehospital and trauma care systems,
Skin Abrasions AIS score = 1 as well as establishing local, regional, and national trauma registries.
Conglomeration of multicentre data can then be used to further examine
Injury Severity Score (ISS) and improve trauma care in African countries.
A TR typically includes detailed information about injured patients,
2
2
ISS = 4 + 4 + 4 = 48. This is a severe injury.
2
including prehospital data, resuscitation efforts, and outcome data. The
actual data points may vary between registries, but it is important that
Paediatric Trauma Score (PTS)
23
they be detailed and consistently collected among patients. Too few
Weight 35 kg +2 data points will lead to incomplete and ineffective data, and too many
24
data points will be cumbersome and impossible to maintain.
Airway Maintainable +1 Unfortunately, a number of resources are needed to implement and
maintain a TR. This begins with a well-defined patient population. Some
SBP 78 mm Hg +1
registries record data only on the severely injured and those who arrive
CNS Obtunded +1 at the hospital alive. Some registries record data dependent on length of
stay of the patient. Most registries derive some score of injury severity
Open Wound None +2 for all registered patients. Careful consideration must be given when
defining the patient population because exclusion of certain patients may
Skeletal Fracture Closed fracture +1 skew the data, altering the apparent severity of injury and affecting later
25
conclusions based on the data. Personnel must be adequately trained
PTS = 8. Such a patient should be triaged immediately to a
paediatric trauma centre, where available. to collect and enter ongoing data. In the United States, a nationally
recognised certification process has been initiated to ensure appropriately
Revised Trauma Score (RTS)
trained staff. The data must be collected by using reasonable and
Weight = dependable software, with the ability to grow and expand as more
GCS = 10 Coded value = 3
0.9368 patients are registered as well as the ability to protect patient privacy. Of
Weight = course, ultimately, all of these resources require funding. Possible sources
SBP = 78 Coded value = 3
0.7326 of funding to establish trauma registries throughout Africa include
Weight = the ministry of health of each participating country, nongovernmental
RR = 28 Coded value = 4
0.2908 organisations (NGOs), and international development partners.
RTS = (0.9368 x 3) + (0.7326 x 3) + (0.2908) = 2.8104 + 2.1978 + Barriers to the creation of trauma registries throughout Africa are
1.1632 = 6.1714 many. The most prominent roadblock is that those tools that have been
established and validated in other systems may not be applicable to the
African population. 26-31 Also, the lack of a continuous power supply may
of the hospital, his GCS was found to be 10, with an RR of 28 cycles
limit the ability to record and maintain data. This may be surmounted
per minute and a SBP of 78 mm Hg. His airway was maintainable. A
by backing up data daily. Further barriers to the establishment of
computed tomography (CT) scan revealed a right-sided parietal subdural
efficient TRs in developing countries are the following:
23
haematoma. It was also revealed by CT scan that he had a grade IV
• little or no prehospital care;
laceration of the spleen. Radiography of the chest and right femur
showed fractures of four ribs on the right and a femoral shaft fracture. • nonavailability of (or inefficient) evacuation and transportation
Paediatric trauma care has improved a great deal in the developed system;
and industrialised countries as a result of standardisation of patient
• limited interhospital communication in the case of transfers;
assessment and reporting. The various scoring systems, especially
those combining anatomic and physiologic parameters, have helped to • lack of standardised and uniform hospital data formats;
improve the care of trauma patients. A search of the African literature,
• limited availability of electronic data storage and retrieval facilities;
especially by using African Journals Online (AJOL), did not reveal
much activity in the use of these scoring systems. This deficiency needs • inadequate funding;
to be rectified because some of these injury scoring systems are easily • unfavourable government health policies;
implemented without extra funding, yet may improve patient outcomes.
• inadequate census and population data; and
Trauma Registry
A trauma registry (TR) is an accurate and comprehensive collection of • lack of awareness in the communities.
data on patients who receive hospital management for specified types Despite these obstacles, existing trauma registries in developed
of injuries. A TR provides an important and ongoing analytical tool to countries can be used as initial guides to create a system that is
assess the management of patient care. The purposes 18–20 of any TR are applicable in resource-poor areas.