Evaluation of emergency department admissions of mass casualty patients using the revised trauma score, injury severity score, and trauma and injury severity score.

BACKGROUND: There is a need for studies evaluating prognostic scoring systems in mass trauma patients in conflict regions to predict patient prognosis for emergency surgical prioritization. In this study, we aimed to evaluate scoring systems such as the Revised Trauma Score (RTS), Injury Severity Score (ISS), and Trauma and Injury Severity Score (TRISS) in trauma patients admitted due to mass trauma in Northern Syria. METHODS: This study was a retrospective evaluation of patients admitted due to mass trauma to the emergency departments of hospitals in Northern Syria. The diagnostic efficiency of RTS, ISS, and TRISS scoring systems was evaluated in these admissions in the first half of 2021. RESULTS: The most common causes of mass trauma were bomb blast (67.3%), gunshot (28.8%), and 14 (3.9%) patients admitted with other causes. When the odds ratio (OR) was analyzed, a one-unit increase in the RTS score increased the odds of survival by a factor of 6.133, and a one-unit increase in the TRISS score increased the odds of survival by a factor of 1.057. Differently, it was found that each 1-unit increase in ISS decreased the patient's probability of survival by 0.856 units. When RTS, TRISS, and ISS scores were analyzed, the area under the ROC curve was statistically significant for all of them (p<0.001) and all of them had a diagnostic value for mortality with sensitivities of 99.0%, 94.8%, and 91.9%; specificities of 87.8%, 90.5%, and 88.6; AUC of 0.958, 0.975, and 0.958, respectively. CONCLUSION: The use of trauma scoring systems, especially TRISS, may be useful for prioritizing patients in mass casualty settings in the presence of overcapacity.

Evaluation of clinical outcomes and comparison of prediction models in the burn population hospitalized from the emergency department: Can burn mortality scores be used in a post-conflict area such as northwest Syria?

BACKGROUND: Burns are a global health problem, especially in low- and middle-income countries. The use of models to predict mortality is more common in developed countries. In northern Syria, internal unrest has continued for 10 years. A lack of infrastruc-ture and difficult living conditions increase the incidence of burns. This study in northern Syria contributes to the predictions of health services provided in conflict regions. The first objective of this study specific to northwestern Syria was to assess and identify risk factors in the burn victim population hospitalized as emergencies. The second objective was to validate the three well-known burn mortality prediction scores to predict mortality: the Abbreviated Burn Severity Index (ABSI) score, Belgium Outcome of Burn Injury (BOBI) score, and revised Baux score. METHODS: This was a retrospective analysis of the database of patients admitted to the burn center in northwestern Syria. Patients who were admitted to the burn center as emergencies were included in the study. Bivariate logistic regression analysis was performed to compare the effectiveness of the three included burn assessment systems in determining the risk of patient death. RESULTS: A total of 300 burn patients were included in the study. Of them, 149 (49.7%) were treated in the ward, and 46 (15.3%) in the intensive care unit; 54 (18.0%) died, and 246 (82.0%) survived. The median revised Baux scores, BOBI scores, and ABSI scores of the deceased patients were significantly higher than those of the surviving patients (p=0.000). The cut-off values for the revised Baux, BOBI, and ABSI scores were set at 105.50, 4.50, and 10.50, respectively. For predicting mortality at these cut-off values, the revised Baux score had a sensitivity of 94.4% and a specificity of 91.9%, and the ABSI score had a sensitivity of 68.8% and a specificity of 99.6%. However, the cut-off value of the BOBI scale, calculated as 4.50, was found to be low (27.8%). The low sensitivity and negative predictive value of the BOBI model suggest that it was a weaker predictor of mortality than the others. CONCLUSION: The revised Baux score was successful in predicting burn prognosis in northwestern Syria, a post-conflict region. It is reasonable to assume that the use of such scoring systems will be beneficial in similar post-conflict regions where limited opportunities exist.