In-Hospital Study of Combined Trauma Score and Outcome in Poly Trauma

Background: Several Trauma scores are utilized to evaluate the injured victim. Physiologic, anatomic, combined (anatomic and physiologic) scoring systems are commonly used. There is no consensus on the best predictor of mortality and morbidity. Aim and Objective: To report in-hospital mortality and disability of polytrauma cases in our trauma center. We studied and compare the clinical and radiological parameters to trauma scores (RTS and NISS) and their outcome. Methods: The study included all injured polytrauma cases aged 14-65 years, between June 2015 to July 2017 at Trauma Centre and Super specialty Hospital, Department of General-Surgery, Institute of Medical Sciences, Varanasi. Pregnant women or patients having preexisting co-morbid conditions were excluded. Demographics profile, vital, MOI, NISS, RTS, blood transfusion, length of stay, and mortality recorded. Cases were divided into two groups: survived and expired. Results: Out of 61 polytrauma cases, 88.5% of cases were survived and 11.5% were expired. The mean age at presentation was 38.74 ± 13.22 years (range 18-65 years). Majority 77% of cases had RTI followed by FFH 21.3% and structural collapse 1.6%. FAST positive in 47.5%. Out of 61 cases, 12 (19.7%) had ICU requirement, 40 (65.5%) had blood transfusion and shock in 58 (95.1%). The mean NISS was significantly low in the survived group (p=0.001) and RTS was significantly high in the survived group as compared to the expired group (p=0.001). The hospital stay was also significantly high in the survived group (p=0.049). On comparing the mean change in GCS, SBP, RR, RTS, and NISS at presentation and discharge which showed statistically significant change (p=0.003, p<0.001, p<0.001, p<0.001, p=0.037). In our study, the cutoff point of NISS for predicting mortality was 20 (sensitivity, 100%; specificity, 73%). The cutoff point of RTS for predicting mortality was 4.5 (sensitivity, 85%; specificity, 100%). Conclusion: Based on observation, the NISS is a better predictor compared to RTS in terms of their outcome in polytrauma cases.