REVISED TRAUMA SCORE AS A PREDICTOR OF OUTCOME IN TRAUMA CASES: EXPERIENCES AT A TERTIARY CARE HOSPITAL IN KARACHI, PAKISTAN.

BACKGROUND: Trauma scores help classify trauma patients, and assist in clinical decision-making. The Revised Trauma Score (RTS) is widely used internationally but its effectiveness as a tool for predicting outcome in paediatric trauma patients in our setting, has yet to be established, mainly owing to lack of use. The aim of this study was to determine the effectiveness of RTS as a predictor of outcome in paediatric trauma patients in Pakistan. METHODS: We conducted a retrospective review of patient medical records at Aga Khan University Hospital, Karachi, from October 2006 to October 2009 and all patients aged less than 14 years, presenting with trauma were selected. Information was collected regarding demographics, vital signs at the time of presentation, length of stay (LOS) in the ward, ICU and the hospital, complications during hospital stay and mortality. Data was analysed in SPSS-17.0. RESULTS: The sample was 501 patients with a mean age of 5.3 years. Two third (66%) were males and 34% were females. Using available data, RTS was calculated for 394 patients, who were then divided into two groups based on the RTS. For 32 patients with a RTS less than 10, the length of stay in the ward, ICU and the hospital were all shorter than the 363 patients with a RTS greater than 10 (p-value <0.001). CONCLUSION: In our setting, RTS is a good predictor of outcome in paediatric trauma patients. It can aid in the assessment of severity of injury in, and objective assessment and triaging of paediatric trauma patients.

Thalassemia and premarital screening: potential for implementation of a screening program among young people in Pakistan.

Pakistan has a high prevalence of ß-thalassemia (ß-thal) but lacks a screening program for its prevention. This questionnaire-based cross-sectional study was conducted in six randomly chosen non medical universities to assess the students' knowledge of ß-thal and premarital screening, and their attitude towards such a program. Comparison was made between the respondents' attitude towards premarital screening before and after providing them some information regarding the disease. Only 54.5% (207) of 380 students had heard of ß-thal, with a mean knowledge score of 13.0 ± 4.4 out of 27 questions. Most respondents were aware of the concept of premarital screening. Out of 207 students, 60.4% wanted to know if they were carriers, 69.1% wanted to know their spouse's carrier status and 59.4% wanted premarital screening to be made mandatory in Pakistan. These figures increased to 72.5, 78.3 and 67.6%, respectively after provision of written information (p values: 0.03, 0.02, and 0.01, respectively). The positive attitude towards premarital screening with low background knowledge of the disease highlights the need of a mass awareness campaign and subsequent implementation of a premarital screening program.

Isolated cryptococcal osteomyelitis in an immunocompetent patient.

Cryptococcosis is a rare infection in HIV-negative individuals. While the lungs and the central nervous system are most commonly infected, skeletal cryptococcosis is uncommon and isolated osteomyelitis due to Cryptococcus neoformans is quite rare. To our knowledge, only 47 cases of isolated cryptococcal osteomyelitis have been reported from 1974 to 2005. We report a case of isolated cryptococcal osteomyelitis in an immunocompetent patient, who received 12 weeks of fluconazole with complete recovery.