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170 Paediatric Injury Scoring and Trauma Registry

The implementation of the Kampala Trauma Score (KTS), a Ideally, it would begin with the establishment of regional and state
simplified system first introduced in Uganda, has fueled the hope that registries, followed by national registries. These can then be grouped
these barriers can be overcome. The KTS is a simplified conglomerate into subregional registries, including North, East, South, and West
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of the RTS and the ISS, resembling the TRISS. Its validity and African registries, which will eventually combine to form the African
reliability have been demonstrated in both urban and rural settings Trauma Registry Database (ATRD).
in Uganda. 33–35 This hospital-based registry was initiated as the first Evidence-Based Research
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step in an injury surveillance system. Data were collected regarding
demographics, injury causation, and outcomes by using a single-page Table 26.11 presents a literature review of scoring systems for paedi-
form. The project was subsequently expanded to include five large atric trauma, and Table 26.12 presents a report on the establishment of
hospitals in Kampala as well as Addis Ababa in Ethiopia. 35,36 the first national Italian trauma registry.
The organisation of a continent-wide paediatric trauma registry in Table 26.12: Evidence-based research.
Africa will require the participation of many hospitals in all countries.
Title The first Italian trauma registry of national relevance:
Table 26.11: Evidence-based research. methodology and initial results
Authors Bartolomeo SD, Nardi G, Sanson G, et al.
Title ABCs of scoring systems for pediatric trauma
Institution Unit of Hygiene and Epidemiology, DPMSC School of
Authors Furnival RA, Schunk JE Medicine, University of Udine, Udine, Italy
Institution Department of Pediatrics, Primary Children’s Medical Center, Reference Eur J Emerg Med 2006; 13:197–203
University of Utah School of Medicine, Salt Lake City, Utah,
USA Problem Endeavour to establish a multiregional trauma registry in
Italy.
Reference Pediatr Emerg Care 1999; 15(3):215–223
Comparison/ The evidence of success in Italy so far is good, and the goals
Problem An overview of frequently used trauma scoring systems.
control of the project have been achieved.
Intervention Literature review. (quality of
Comparison/ This literature review does not compare patients, per evidence)
control se, but compares the effectiveness of various trauma Outcome/ The possibility of using the data collected for future quality
(quality of scoring systems in the paediatric age group with or without effect improvement and research appear great, and there are steps
modifications. The many existing trauma scoring systems
evidence) are divided into triage scoring systems, injury scoring to link this registry to other European trauma registries. It is
also envisaged that, considering its success, other hospitals
systems, and trauma outcome analysis systems, each with in Italy will offer to participate in such a registry.
its advantages and limitations when used in children.
Historical This is a beginning worth emulating in the African subregion
Outcome/ The scoring systems are designed to enhance effective significance/ if we want to build a recognisable trauma registry for Africa.
effect prehospital triage of trauma patients, organise and Not all African countries have to start at the same time; the
improve trauma system resource planning, allow accurate comments end result will be the same eventually, if we follow other
comparison of different trauma populations, and serve as people’s examples.
quality assurance filters in trauma patient care.
Historical This well-written article takes the reader through the
significance/ historical development of some trauma scoring systems and
comments provides a very good overview of frequently used systems.
The authors even inform readers about an ideal scoring
system: it should correlate well with the desired outcome
(e.g., death, disability, costs, etc.); it should be reasonable
to clinicians and correlate with their judgement; it should use
available data; it should be reliable among different users;
and it should be simple. This is, in fact, what all scoring
systems should be.

Key Summary Points

1. Trauma scoring systems are grouped into three sections: 5. The most widely used systems include the Revised Trauma
anatomic, physiologic, and combined scoring systems. Score (RTS), Paediatric Trauma Score (PTS), Abbreviated
Injury Scale (AIS), Injury Severity Score (ISS) and its
2. Each system has its place of use and must be used modifications, and the Trauma and Injury Severity Score
appropriately.
(TRISS).
3. Each system has its advantages and disadvantages, and these 6. A trauma registry collects and maintains data on patients who
must be weighed carefully before a particular system is chosen have had injuries and is used for planning to develop newer
for use in a clinical setting.
methods of trauma care as well as quality assurance.
4. The system chosen must be reproducible, or at least should be 7. Trauma registry data are confidential and must be treated as such.
reliable and simple.