A. A. Shah1,2, A. Rehman2, S. Shah2, H. Zafar2, C. K. Zogg1, S. Zafar3, Z. Rehman2, Y. Bashir2, A. H. Haider1 1Johns Hopkins University School Of Medicine,Center For Surgical Trials And Outcomes Research, Department Of Surgery,Baltimore, MD, USA 2Aga Khan University Medical College,Department Of Surgery,Karachi, Sindh, Pakistan 3Howard University College Of Medicine,Department Of Surgery,Washington, DC, USA
Introduction: Penetrating abdominal trauma is a common feature of trauma treated in low- and middle-income countries (LMICs). Two measures: the Penetrating Abdominal Trauma Index (PATI) and the Injury Severity Score (ISS), are often utilized by hospitals in LMICs to measure the injury severity of penetrating abdominal wounds. However, it remains unclear which measure better accounts for the severity of injuries that a patient sustains. The purpose of this study was to compare the efficacy of both injury severity measures at predicting outcomes in patients presenting to a low-middle income healthcare facility in Pakistan.
Methods: All isolated gunshot wounds to the abdomen presenting to a university hospital between 2011-2012 were included. Information was retrieved on patient demographics, injury type and mechanism, complications, mortality and length of stay. ISS and PATI were calculated for each case. Primary outcome measures included all-cause mortality and complications. Multivariate analysis adjusting for age, gender, referral status, hypotension, tachycardia, and injury severity measures was performed. Areas under receiver operating curves (AUROC) were further calculated to compare the respective abilities of ISS and PATI to predict death and complications.
Results: A total of 70 patients were included. Average age was 34.5 (±11.4) years, with a male predominance (n=68, 97.1%). The majority of gunshot wounds were intentionally inflicted (n=67, 95.7%). Crude rates of death and complications were 34.3% and 15.7%, respectively. Mean patient ISS was 17.2 (±8.0), and mean PATI was 18.8 (±11.1). AUROC analyses revealed ISS to be comparable to PATI at predicting mortality (AUROC [95%CI]: 0.952 [0.902-1.00] vs. 0.934 [0.860-1.00]). PATI was found to be as good as the ISS at predicting complications relative (AUROC [95% CI]: 0.895 [0.815-0.975] vs. 0.868 [0.778-0.959]).
Conclusion: The predictive ability of ISS and PATI severity measures was found to be comparable in patients with abdominal gunshot wounds treated at a university hospitals in a LMIC. ISS is regularly employed to quantify injury severity around the globe. We recommend its use as the standard injury severity measure, even for penetrating abdominal trauma given its widespread recognition and comparable utility to a lesser-known abdomen-specific measure.
