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Malawi Trauma Score is Predictive of Mortality at a District Hospital: A Validation Study

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Abstract

Background

Trauma scoring systems can identify patients who should be transferred to referral hospitals, but their utility in LMICs is often limited. The Malawi Trauma Score (MTS) reliably predicts mortality at referral hospitals but has not been studied at district hospitals. We sought to validate the MTS at a Malawi district hospital and evaluate whether MTS is predictive of transfer to a referral hospital.

Methods

We performed a retrospective study using trauma registry data from Salima District Hospital (SDH) from 2017 to 2021. We excluded patients brought in dead, discharged from the Casualty Department, or missing data needed to calculate MTS. We used logistic regression modeling to study the relationship between MTS and mortality at SDH and between MTS and transfer to a referral hospital. We used receiver operating characteristic analysis to validate the MTS as a predictor of mortality.

Results

We included 2196 patients (84.3% discharged, 12.7% transferred, 3.0% died). These groups had similar ages, sex, and admission vitals. Mean (SD) MTS was 7.9(3.0) among discharged patients, 8.4(3.9) among transferred patients, and 14.2(8.0) among patients who died (p < 0.001). Higher MTS was associated with increased odds of mortality at SDH (OR 1.21, 95% CI 1.14–1.29, p < 0.001) but was not related to transfer. ROC area for mortality was 0.73 (95% CI 0.65–0.80).

Conclusions

MTS is predictive of district hospital mortality but not inter-facility transfer. We suggest that MTS be used to identify patients with severe trauma who are most likely to benefit from transfer to a referral hospital.

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Acknowledgements

This study was supported by the NIH Fogarty International Center (Grant #D43TW009340).

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Authors and Affiliations

  1. Department of Surgery, UNC School of Medicine, University of North Carolina, 4008 Burnett Womack Building, Chapel Hill, CB, 7228, USA

    Avital Yohann, Laura N. Purcell, Jared Gallaher & Anthony Charles

  2. Salima District Hospital, Salima, Malawi

    Yonasi Chise & Chiphatso Manjolo

Authors
  1. Avital Yohann
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  2. Yonasi Chise
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  3. Chiphatso Manjolo
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  4. Laura N. Purcell
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  5. Jared Gallaher
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  6. Anthony Charles
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Correspondence to Anthony Charles.

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Study Approval

This study was approved by the University of North Carolina Institutional Review Board and the Malawi National Health Sciences Research Committee.

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Yohann, A., Chise, Y., Manjolo, C. et al. Malawi Trauma Score is Predictive of Mortality at a District Hospital: A Validation Study. World J Surg 47, 78–85 (2023). https://doi.org/10.1007/s00268-022-06791-8

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