title: Diagnostic accuracy of the Kampala Trauma Score using estimated Abbreviated Injury Scale scores and physician opinion.
abstract: BACKGROUND
  The Kampala Trauma Score (KTS) has been proposed as a triage tool for use in low- and middle-income countries (LMICs). This study aimed to examine the diagnostic accuracy of KTS in predicting emergency department outcomes using timely injury estimation with Abbreviated Injury Scale (AIS) score and physician opinion to calculate KTS scores.
  
  
  METHODS
  This was a diagnostic accuracy study of KTS among injured patients presenting to Komfo Anokye Teaching Hospital A&E, Ghana. South African Triage Scale (SATS); KTS component variables, including AIS scores and physician opinion for serious injury quantification; and ED disposition were collected. Agreement between estimated AIS score and physician opinion were analyzed with normal, linear weighted, and maximum kappa. Receiver operating characteristic (ROC) analysis of KTS-AIS and KTS-physician opinion was performed to evaluate each measure's ability to predict A&E mortality and need for hospital admission to the ward or theatre.
  
  
  RESULTS
  A total of 1053 patients were sampled. There was moderate agreement between AIS criteria and physician opinion by normal (κ=0.41), weighted (κlin=0.47), and maximum (κmax=0.53) kappa. A&E mortality ROC area for KTS-AIS was 0.93, KTS-physician opinion 0.89, and SATS 0.88 with overlapping 95% confidence intervals (95%CI). Hospital admission ROC area for KTS-AIS was 0.73, KTS-physician opinion 0.79, and SATS 0.71 with statistical similarity. When evaluating only patients with serious injuries, KTS-AIS (ROC 0.88) and KTS-physician opinion (ROC 0.88) performed similarly to SATS (ROC 0.78) in predicting A&E mortality. The ROC area for KTS-AIS (ROC 0.71; 95%CI 0.66-0.75) and KTS-physician opinion (ROC 0.74; 95%CI 0.69-0.79) was significantly greater than SATS (ROC 0.57; 0.53-0.60) with regard to need for admission.
  
  
  CONCLUSIONS
  KTS predicted mortality and need for admission from the ED well when early estimation of the number of serious injuries was used, regardless of method (i.e. AIS criteria or physician opinion). This study provides evidence for KTS to be used as a practical and valid triage tool to predict patient prognosis, ED outcomes and inform referral decision-making from first- or second-level hospitals in LMICs.
authors.affiliation: Medical School, University of Michigan, Ann Arbor, USA. Electronic address: aellisgardner@gmail.com.
authors.forename: Andrew
authors.initials: A
authors.lastname: Gardner
authors.affiliation: Department of Emergency Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
authors.forename: Paa Kobina
authors.initials: PK
authors.lastname: Forson
authors.affiliation: Department of Emergency Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
authors.forename: George
authors.initials: G
authors.lastname: Oduro
authors.affiliation: Department of Surgery, University of Washington, Seattle, USA; Department of Surgery, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
authors.forename: Barclay
authors.initials: B
authors.lastname: Stewart
authors.affiliation: Department of Emergency Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
authors.forename: Nkechi
authors.initials: N
authors.lastname: Dike
authors.affiliation: Department of Emergency Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
authors.forename: Paul
authors.initials: P
authors.lastname: Glover
authors.affiliation: Department of Emergency Medicine, University of Michigan, Ann Arbor, USA.
authors.forename: Ronald F
authors.initials: RF
authors.lastname: Maio
mesh_terms: D015998:Abbreviated Injury Scale; D000328:Adult; D001291:Attitude of Health Personnel; D004636:Emergency Service, Hospital; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D010820:Physicians / Q000523:psychology*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D015599:Trauma Severity Indices; D014218:Triage / Q000379:methods; D014947:Wounds and Injuries / Q000175:diagnosis* / Q000401:mortality
keywords: Global surgery; Kampala Trauma Score; Trauma; Trauma severity indices; Triage