title: Abdominal gunshot wounds-a comparative assessment of severity measures.
abstract: BACKGROUND
  Penetrating abdominal trauma is a common feature of trauma treated in low- and middle-income countries (LMICs). The penetrating abdominal trauma index (PATI) and the injury severity score (ISS) are severity-measures most often used to gauge injury severity. It remains unclear which measure better accounts for the severity of sustained injuries. This study compares the predictive ability of both injury severity measures in patients presenting to an LMIC in South Asia.
  
  
  METHODS
  All isolated gunshot wounds to the abdomen presenting to a university hospital between 2011 and 2012 were included. ISS and PATI were calculated for each case. Primary outcome measures included all-cause mortality and complications. Multivariable analysis adjusting for age, sex, referral status, hypotension, tachycardia, and injury severity measures was performed. The area under the receiver operating characteristic (AUROC) curve were further calculated to compare the respective abilities of ISS and PATI at predicting death and complications.
  
  
  RESULTS
  A total of 70 patients were included. The average age on presentation was 34.5 y (±11.4) within a predominantly male (n = 68, 97.1%) cohort. Most gunshot wounds were intentionally inflicted (n = 67, 95.7%). The crude rates of death and complications were 34.3% and 15.7%, respectively. The median ISS was 14 (interquartile range: 11-21), and the median PATI was 16 (interquartile range: 9-26). AUROC analysis revealed that ISS was comparable with PATI at predicting mortality (AUROC [95% confidence interval]: 0.952 [0.902-1.00] versus 0.934 [0.860-1.00]) and complications (AUROC [95% confidence interval]: 0.868 [0.778-0.959] versus 0.895 [0.815-0.975]).
  
  
  CONCLUSIONS
  The predictive ability of ISS and PATI severity measures was found to be comparable. The results suggest that both measures can be used to risk-stratify patients with isolated abdominal gunshot wounds in an LMIC.
authors.affiliation: Center for Surgery and Public Health, Harvard Medical School and Harvard School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan. Electronic address: adl_ajz@yahoo.com.
authors.forename: Adil Aijaz
authors.initials: AA
authors.lastname: Shah
authors.affiliation: Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Abdul
authors.initials: A
authors.lastname: Rehman
authors.affiliation: Medical College, Aga Khan University, Karachi, Pakistan.
authors.forename: Syed Jawad
authors.initials: SJ
authors.lastname: Shah
authors.affiliation: Center for Surgery and Public Health, Harvard Medical School and Harvard School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Adil H
authors.initials: AH
authors.lastname: Haider
authors.affiliation: Center for Surgery and Public Health, Harvard Medical School and Harvard School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Cheryl K
authors.initials: CK
authors.lastname: Zogg
authors.affiliation: Department of Surgery, Howard University College of Medicine, Washington, DC.
authors.forename: Syed Nabeel
authors.initials: SN
authors.lastname: Zafar
authors.affiliation: Medical College, Aga Khan University, Karachi, Pakistan.
authors.forename: Yousaf Bashir
authors.initials: YB
authors.lastname: Hadi
authors.affiliation: Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
authors.lastname: Zia-Ur-Rehman
authors.affiliation: Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Hasnain
authors.initials: H
authors.lastname: Zafar
mesh_terms: D000007:Abdominal Injuries / Q000453:epidemiology* / Q000601:surgery; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014948:Wounds, Gunshot / Q000453:epidemiology* / Q000601:surgery; D055815:Young Adult
keywords: Area under receiver operating characteristic; Injury severity score; Low-middle income country; Penetrating abdominal trauma; Penetrating abdominal trauma index; Prognosis