Is Kampala Trauma Score the Solution to Improving Trauma Care and Reducing Mortality in Africa?
Background
Trauma is a significant public health issue, particularly in low- and middle-income countries (LMICs). According to the World Health Organization (WHO), about 1.19 million people die annually due the road traffic accidents (RTAs)[1]. Additionally, the WHO estimates that every six seconds, someone dies from an injury[2]. In Africa, trauma is responsible for 9 out of 10 injury-related deaths, which contribute to 9% of total mortality globally[3]. Notably, 90% of the global injury-related deaths occur in LMICs, including Africa as a result of RTAs, interpersonal violence such as assaults as well as wars and conflicts[4].
Fundamentally, trauma can be emotional or physical. In physical medicine, trauma refers to damage to the tissue or an injury. Research has also shown that there have been more RTAs in Africa over the past decades[5], which can be attributed to bad roads, driver’s negligence, just to mention a few[6]. Efforts to reduce the burden of injury related mortalities in Africa rely heavily on data collection to understand injury epidemiology in the bid to increase injury prevention strategies and strengthen the healthcare system. Additionally, Africa bears the burden of dearth of resources, hence the need for standardized healthcare systems to ensure that the patients’ health is maximized, and injury-related morbidities are minimized.
Trauma has a significant impact on communities and individuals in Africa. Irrespective of where the trauma stems from, it leaves an indelible mark on the mental, emotional and psychosocial wellbeing of the victims. However, the effect of trauma can be managed and prevented through various means; community-based trauma support, targeted interventions, trauma programs, and breaking the silence. In high income countries, these interventions have led to strengthened trauma care systems, which has improved trauma and injury outcomes, the presence of these interventions in low-and-middle-income countries will go a long way in averting one third of the injury and trauma deaths.
Trauma Scoring System
Trauma is a significant public health issue, particularly in low- and middle-income countries (LMICs). According to the World Health Organization (WHO), about 1.19 million people die annually due the road traffic accidents (RTAs). Additionally, the WHO estimates that every six seconds, someone dies from an injury. In Africa, trauma is responsible for 9 out of 10 injury-related deaths, which contribute to 9% of total mortality globally. Notably, 90% of the global injury-related deaths occur in LMICs, including Africa as a result of RTAs, interpersonal violence such as assaults as well as wars and conflicts.
Fundamentally, trauma can be emotional or physical. In physical medicine, trauma refers to damage to the tissue or an injury. Research has also shown that there have been more RTAs in Africa over the past decades, which can be attributed to bad roads, driver’s negligence, just to mention a few. Efforts to reduce the burden of injury related mortalities in Africa rely heavily on data collection to understand injury epidemiology in the bid to increase injury prevention strategies and strengthen the healthcare system. Additionally, Africa bears the burden of dearth of resources, hence the need for standardized healthcare systems to ensure that the patients’ health is maximized, and injury-related morbidities are minimized.
Trauma has a significant impact on communities and individuals in Africa. Irrespective of where the trauma stems from, it leaves an indelible mark on the mental, emotional and psychosocial wellbeing of the victims. However, the effect of trauma can be managed and prevented through various means; community-based trauma support, targeted interventions, trauma programs, and breaking the silence. In high income countries, these interventions have led to strengthened trauma care systems, which has improved trauma and injury outcomes, the presence of these interventions in low-and-middle-income countries will go a long way in averting one third of the injury and trauma deaths.
Over the past 30 years, studies have been made on trauma care and this led to the development of various trauma scores.[7] The existing trauma scores include – Harvard trauma scores, the revised trauma score, Triage index, Acute trauma index, the Kampala trauma score, Prognostic index, Glasgow coma scale and paediatric Glasgow coma scale and so much more. These trauma scoring systems assess the severity of a patient using the host vulnerability, anatomical and physiological severity. The trauma scoring system as a tool measures the age, gender, neurological function using the Glasgow coma scale, the cardiovascular status as well as the respiratory rate and assigns a score, which helps the healthcare professional make an informed decision concerning patients.
The most used in trauma medicine are Injury severity score (ISS) and Reversed trauma scale (RTS). The ISS provides a comprehensive assessment of injury severity, while RTS is primarily for initial triage, playing crucial roles in trauma care. The ISS works by categorizing the human body into 9 areas and assigns an injury score to each area, and the overall ISS is gotten by summing up the squares of the highest injury scores in the three most severely injured body regions. The RTS has a total score of 12 and a score below 11 indicates the need for transport to a specialized trauma center. Furthermore, these scoring systems work very well for industrialised and high-income countries but poses a challenge for LMICs where advanced diagnostic tools, comprehensive medical records, and adequate manpower are limited[8]. It is necessary to develop a trauma score that works with the healthcare system considering the unique characteristics of Africa.
The Kampala Trauma Score
Amidst the emergency room chaos, a simple, yet powerful tool for trauma assessment was introduced. The Kampala trauma score (KTS), developed by Kobusingye in the year 2000, is a feasible front-line triage tool that uses less variables compared to other triage tools[9]. KTS is a robust predictor of mortality that contains the relevant components such as the age, blood pressure, respiration and neurological status for assessing the severity of an injury. It has a score of one (1) to ten (10), with the lowest indicating severity. When compared with estimated ISS in previous studies, KTS has shown capacity in predicting mortality in multi-trauma patients. Additionally, it evaluates injuries based on physiological factors rather than anatomical factors.
A desk review of the Scopus database showed 69 articles on KTS, of which 47 of them documented the use of KTS in some African countries – Uganda, South Africa, Tanzania, Rwanda, Malawi, Kenya, Ethiopia, Cameroon and Ghana. It was evident that hospitals and healthcare professionals in African countries use the other trauma scoring systems other than the KTS[10]. Although the KTS is similar to other triage tools, a study in Malawi showed that KTS is a statistically significant predictor of need for hospital admission[11]. There is the need for African countries to adopt the KTS as the gold standard for triaging trauma patients in the hospital due to its simplicity, and cost effectiveness.
KTS has demonstrated its effectiveness over the past two decades, especially in low- and middle-income countries where there are limited resources. Notably, KTS has been used in over 16 countries in LMICs and has the potential of being scaled up to high income countries that do not currently measure injury severity. Aside from KTS’s applicability to LMIC and Africa, other major advantages that KTS possess include its simplicity, accuracy, wide validation, early and late mortality prediction, proven track record, and reduced resource requirement. Overall, 80% of studies on KTS highlighted that it either equaled or exceeded the ISS. With the above features, KTS remains a valuable, valid and an efficient alternative for the African context.
Conclusion
With Africa bearing the burden of diseases globally, it is imperative that the continent starts innovating localized and effective strategies and tools to address the continent’s health challenges. One of these innovations is the Kampala trauma score, and here is a call for African’s healthcare professionals to use this effective tool to continue to save lives. There are no doubts that KTS is poised to revolutionize trauma care management in Africa and by extension LMICs.
References
[1] World Health Organization (2021). Roads and injuries. Accessed on 10/06/2024. Available at https://www.who.int/news-room/fact-sheets/detail/road-traffic-injuries
[2] World Health Organization (2014). Injuries and violence. The facts. Accessed on 11/06/2024. Available at https://www.who.int/publications/i/item/9789241508018
[3] World Health Organization (2021). Injuries and violence. Accessed on 10/06/2024. Available at https://www.who.int/news-room/fact-sheets/detail/injuries-and-violence#
[4] Wyatt, G. E., Thames, A., Simbayi, L., Stein, D. J., Burns, J., & Maselesele, M. (2017). Trauma and mental health in South Africa: Overview. Psychological Trauma: Theory, Research, Practice, and Policy, 9(3), 249–251. https://doi.org/10.1037/tra0000144
[5] Chen, G. (2010). Road traffic safety in African countries – status, trend, contributing factors, countermeasures and challenges. International Journal of Injury Control and Safety Promotion, 17(4), 247–255. https://doi.org/10.1080/17457300.2010.490920
[6] Lefering, R. Trauma Score Systems for Quality Assessment. Eur J Trauma 28, 52–63 (2002). https://doi.org/10.1007/s00068-002-0170-y
[7]Jessica K. Willett, (2019). Imaging in trauma in limited-resource settings: A literature review. African Journal of Emergency Medicine, Volume 9, Supplement. Pages S21-S27, ISSN 2211-419X. https://doi.org/10.1016/j.afjem.2018.07.007
[8] Manoochehry S, Vafabin M, Bitaraf S, Amiri A (2019) A Comparison between the Ability of Revised Trauma Score and Kampala Trauma Score in Predicting Mortality; a Meta-Analysis. Arch Acad Emerg Med. Jan 15;7(1): e6.
[9] Kobusingye OC, Lett RR (2000). Hospital-based trauma registries in Uganda. J Trauma.Mar;48(3):498-502. doi: 10.1097/00005373-200003000-00022. PMID:0744292.
[10] Perrone, G., Bonati, E., Tarasconi, A., Abongwa, H.K., Catena, F. (2021). Injuries and Scoring Systems. In: Pikoulis, E., Doucet, J. (eds) Emergency Medicine, Trauma and Disaster Management. Hot Topics in Acute Care Surgery and Trauma. Springer, Cham. https://doi.org/10.1007/978-3-030-34116-9_12
[11] Hakimzadeh Z, Vahdati SS, Ala A, Rahmani F, Ghafouri RR, Jaberinezhad M (2024). The predictive value of the Kampala Trauma Score (KTS) in the outcome of multi-traumatic patients compared to the estimated Injury Severity Score (eISS). BMC Emerg Med. 2024 May 14;24(1):82. doi: 10.1186/s12873-024-00989-w.
