Development of an Orthopedic Trauma Score to Predict Mortality in Low and Middle Income Countries in Sub-Sahara Africa: Improving Outcome and Efficient Resource Use

Background: Despite the huge burden of disease in low to middle income countries (LMICs), trauma, especially orthopedic trauma, has not been well studied. Furthermore, trauma scores in LMICs have had variable levels of success and are often applied retrospectively to show potential applicability. The Kampala Trauma Score, KTS, and the Revised Trauma Score, RTS, were both tested as an outcome predictive tool in Kamuzu Central Hospital (KCH) in Lilongwe Malawi but were found not to be strong enough predictors of mortality to be clinically useful. In this paper I propose a research plan to identify risk factors associated with orthopedic injuries that will aid in creating a simple orthopedic trauma score that can be tested in LMICs. Methods: I include patients with orthopedic injuries and exclude any patients with burn, penetrating, or head injuries. I will use appropriate univariate analysis, bivariate analysis, and logistic regression to determine odds ratios and measure the association with certain patterns of orthopedic injuries. Using this data I will develop a simple orthopedic trauma score that can be tested at KCH and potentially other LMICs as a predictor for mortality. Anticipated Results: I am doing a retrospective (secondary data analysis) of prospectively collected data from the KCH Trauma Surveillance Registry from 2008 to 2014 (n = 8914). I anticipate there will be a difference in mortality among those with different types of fracture, pelvic being the most fatal. Additionally, the odds of death will be higher with patients who have multiple fractures. The orthopedic trauma score will include injury location, severity, and patient characteristics that will yield a percent chance of mortality based on score. Conclusions: Orthopedic injuries are likely underestimated as a cause of morbidity and mortality in LMICs and specifically in Malawi. Orthopedic trauma scores could be easy to implement and improve population outcomes leading to a more efficient use of limited resources.Master of Public Healt