Abstract

Injury remains a major public health problem globally, but 90% of all trauma deaths occur in Low-and-Middle-Income-Countries (LMICs), where resources to deal with this crisis are inadequate. Characterization of injury severity is an important pillar of scientific research to measure and compare the outcomes, in order to improve the quality of care. Although no single injury measure is considered the best or the most comprehensive, many have been formulated over time with a wide range of methodologies and are being used in both high-income-countries and LMICs. We conducted the following study to summarize the evidence on performance of injury severity measures based on empirical validation analysis and their applicability in LMIC settings. A systematic search of PubMed, Global Health, and EMBASE on literature published in LMICs from January 2006 through June 2016 was undertaken. We conducted a detailed literature review to assess the application and performance of injury severity measures to predict in-hospital mortality. Studies that applied one or more global injury severity measure(s) on all types of injuries were included, except for those that focused only on war injuries, poisoning, drowning, and ocular trauma. Out of 3862 non-duplicate citations, 597 studies from fifty-four LMICs were listed as eligible studies. Full text review revealed 37 studies describing performance of injury severity measures for outcome prediction. Twenty-five articles from thirteen LMICs assessed the validity of at least one injury severity measure for in-hospital mortality. ISS was the most commonly validated measure in LMICs, with a wide range of performance (AUROC between 0.9–0.65). TRISS validation studies reported AUROC between 0.80 and 0.98. Empirical studies from LMICs frequently utilize injury severity measures, however, no single injury severity measure has shown a consistent result in all settings or populations and thus warrants further validation studies.