Ganga hospital open injury severity score as a predictor of outcomes of gustilo type III tibia fractures, a multicenter study
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Date
2023-12
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Kampala International University
Abstract
Gustilo type III tibia fractures, while common, present considerable challenges in management. The historical approach of emergent amputation has evolved with advancements in antibiotics, aseptic techniques, and microsurgery, shifting towards prioritizing cosmetic and functional restoration. Despite this shift, uncertainty persists regarding limb salvage versus amputation, prompting the development of various extremity scoring systems. Erroneous decisions in this regard can lead to unnecessary or delayed amputations, carrying substantial morbidity and mortality risks. Therefore, a predictive scoring system is essential to guide such critical decisions. This study aimed to assess the discriminatory accuracy of the Ganga Hospital Open Injury Severity Score (GHOISS) in predicting the need for amputation. Over a four-month period, a prospective cohort study enrolled 52 consecutive patients with 53 Gustilo type III tibia fractures from the emergency and orthopedic units of KIUTH and JRRH. Participants were evaluated using the GHOISS scoring system and subsequently managed according to established trauma protocols. Decisions on limb salvage or amputation were made independent of the GHOISS scores. Among 53 tibia fractures, 47 underwent salvage procedures, while 6 necessitated amputation (4 primary and 2 secondary cases). A GHOISS score of 13 demonstrated notable sensitivity and specificity in predicting amputation, with values of 83.3% and 91.5%, respectively. The area under the curve (AUC) for the GHOISS score was 0.933, highlighting its strong predictive capability. The GHOISS scoring system proves to be a dependable predictor of outcomes for Gustilo type III tibia fractures. Notably, a GHOISS score of 13 exhibited the highest sensitivity and specificity for anticipating the need for amputation. It should therefore be used to improve on clinical decisions in the care as well as prognostic counseling of these patients of patients with these injuries.
Description
A thesis submitted to the faculty of clinical medicine and dentistry in partial fulfillment of the requirements for the award of degree of master of medicine in general surgery of Kampala International University