• H Zafar, R Rehmani, A J Raja, A Ali, and M Ahmed.
• Department of Surgery, The Aga Khan University, Karachi, Pakistan. hasnain.zafar@aku.edu
• Emerg Med J. 2002 Sep 1;19(5):391-4.

ObjectiveTo report trauma outcome from a developing country based on the Trauma and Injury Severity Scoring (TRISS) method and compare the outcome with the registry data from Major Trauma Outcome Study (MTOS).DesignRegistry based audit of all trauma patients over two years.SettingEmergency room of a teaching university hospital.Subjects279 injured patients meeting trauma team activation criteria including all deaths in the emergency room.Outcome MeasuresTRISS methodology to compare expected and observed outcome.Statistical AnalysisW, M, and Z statistics and comparison with MTOS data.Results279 patients meeting the trauma triage criteria presented to the emergency room, 235 (84.2%) were men and 44 (15.8%) women. Blunt injury accounted for 204 (73.1%) and penetrating for 75 (26.9%) patients. Seventy two patients had injury severity score of more than 15. Only 18 (6.4%) patients were transported in an ambulance. A total of 142 (50.9%) patients were transferred from other hospitals with a mean prehospital delay of 7.1 hours. M statistic of our study subset was 0.97, indicating a good match between our patients and MTOS cohort. There were 18 deaths with only one unexpected survivor. The expected number of deaths based on MTOS dataset should have been 12.ConclusionsPresent injury severity instruments using MTOS coefficients do not accurately correlate with observed survival rates in a developing country.

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