Comparative statistical performance of prehospital scoring systems with and without incorporating age for predicting multiple trauma outcomes: an observational study.

Injuries are an extremely important problem in public life and account for up to one-third of deaths in the entire human population. Available trauma scoring systems provide a good estimation of mortality; however, some factors affect their utility in daily practice. Therefore, a new easily applicable in any given country trauma scoring system has been developed and proposed in this study. A retrospective study of the medical records of 485 patients were evaluated, together with diagnostic performance with regard to mortality, was calculated for the Revised Trauma Score (RTS), Injury Severity Score (ISS), The New Injury Severity Score (NISS), Trauma and Injury Severity Score (TRISS), International Classification based Injury Severity Score (ICISS) and the newly-developed Life Threat Index (LTI). Sensitivity, specificity, accuracy, PPV and NPV were calculated for each scoring system, and overall diagnostic performance was estimated with the use of ROC curves. Apart from RTS, all scoring systems showed similar performance regarding mortality prediction. TRISS and LTI showed the highest sensitivity reaching 0.998 and AUC of 0.89 and 0.87, respectively, which proved its usefulness in predicting mortality. LTI proved to be one of the most sensitive in comparison with widely-used and recognized trauma scoring systems. Based on LTI methodology, it can be applied in any given country or region, even without a previously developed trauma database.

Hereby, we aimed to comprehensively compare different scoring systems for pediatric trauma and their ability to predict in-hospital mortality and intensive care unit (ICU) admission. The current registry-based multicenter study encompassed a comprehensive dataset of 6709 pediatric trauma patients aged ≤ 18 years from July 2016 to September 2023. To ascertain the predictive efficacy of the scoring systems, the area under the receiver operating characteristic curve (AUC) was calculated. A total of 720 individuals (10.7%) required admission to the ICU. The mortality rate was 1.1% (n = 72). The most predictive scoring system for in-hospital mortality was the adjusted trauma and injury severity score (aTRISS) (AUC = 0.982), followed by trauma and injury severity score (TRISS) (AUC = 0.980), new trauma and injury severity score (NTRISS) (AUC = 0.972), Glasgow coma scale (GCS) (AUC = 0.9546), revised trauma score (RTS) (AUC = 0.944), pre-hospital index (PHI) (AUC = 0.936), injury severity score (ISS) (AUC = 0.901), new injury severity score (NISS) (AUC = 0.900), and abbreviated injury scale (AIS) (AUC = 0.734). Given the predictive performance of the scoring systems for ICU admission, NTRISS had the highest predictive performance (AUC = 0.837), followed by aTRISS (AUC = 0.836), TRISS (AUC = 0.823), ISS (AUC = 0.807), NISS (AUC = 0.805), GCS (AUC = 0.735), RTS (AUC = 0.698), PHI (AUC = 0.662), and AIS (AUC = 0.651). In the present study, we concluded the superiority of the TRISS and its two derived counterparts, aTRISS and NTRISS, compared to other scoring systems, to efficiently discerning individuals who possess a heightened susceptibility to unfavorable consequences. The significance of these findings underscores the necessity of incorporating these metrics into the realm of clinical practice.

Background: Several trauma scoring systems have been widely used to determine the prognosis of trauma patients, but their use for post-surgical fixation of traumatic rib fracture patients has not yet been reported. This study aimed to compare several trauma scoring systems in predicting post-surgical fixation outcomes of traumatic rib fractures. Methods: A retrospective analytical study was conducted at a single tertiary hospital. Inclusion criteria were patients who suffered multiple rib fractures and were eligible for surgical rib fixation from January 2019 to July 2022. The outcomes of the study were the length of hospitalization (LHS) and intensive care unit stay (LICU), duration of thoracostomy tube insertion (DTT), the need for mechanical ventilation (NMV), and mortality post-surgery. The correlations of trauma scoring systems and measured outcomes were evaluated by bivariate and multivariate analysis. Cut-off values were determined utilizing a receiver operating characteristic curve. Results: The study involved 110 patients. All measured trauma scores were significantly correlated with the measured outcomes. Injury Severity Score (ISS) performed better to predict LHS (p=0.004) and DTT (p=0.007). Revised Trauma Score (RTS) was a good predictor of LICU (p≤0.001) and NMV (p=0.001; OR=0.39). Thoracic Trauma Severity Score (TTSS) was independent predictor of mortality (p=0.015; OR=2.28) and the NMV post-surgery (p=0.047; OR=1.320). Conclusion: Patients who have suffered severe thoracic trauma should be assessed using trauma scores, which may predict various in-hospital outcomes and should be used complementarily with other trauma scoring systems to minimize the incidence of mortality and morbidity.

Objective: Prehospital triage of the seriously injured patient is fraught with challenges, and trauma scoring systems in current triage guidelines warrant further investigation. The primary objective of this study was to assess the correlation of the physiologically based Revised Trauma Score (RTS) and MGAP score (mechanism of injury, Glasgow Coma Scale, age, blood pressure) with the anatomically based Injury Severity Score (ISS). The secondary objectives for this study were to compare the accuracy of the MGAP score and the RTS for the prediction of in-hospital mortality for trauma patients. Methods: This study was a retrospective cohort including 10 years of patient data in a large single-center trauma registry at a primary adult resource center (Level I) for trauma patients. Participants included adults (age ≥18 years). The primary outcome measure was injury severity (measured by ISS) and a secondary analysis compared the RTS and MGAP for the prediction of patient mortality. Descriptive statistics were used to describe the cohort and correlation methods were employed. Each score’s accuracy for the prediction of mortality was calculated using the area under receiver operating characteristic (AUROC) curves. Results: In total, 43,082 trauma patient records were reviewed; 32,798 patients had complete RTS data available and 32,371 patients had complete data available for MGAP analyses. The correlation between scene RTS and ISS was poor (−.29), as was the correlation between MGAP and ISS (−.28). For the prediction of mortality, admission MGAP demonstrated the highest sensitivity and specificity for mortality (AUROC 0.96; 95% CI, 0.95–0.96). Conclusions: While elements of the RTS remain the first criterion recommended to quantify the totality of physiological injury severity, the composite RTS score derived from this system correlates poorly with actual anatomical injury severity. The MGAP scoring system demonstrated higher sensitivity and specificity for mortality but was not superior to the RTS for predicting anatomical injury severity. In the future development of national and international field triage guidelines for trauma patients, the findings from this study may be considered in order to improve the accuracy of prehospital triage. The findings in this analysis complement a growing body of evidence that suggests that MGAP may be a superior and more easily calculable prehospital scoring system for the prediction of mortality in trauma patients.

Background In developing nations, the primary cause of death is trauma, and the prevalence of trauma is increasing as more vehicles are driven. Numerous trauma scoring systems have been created in order to predict the mortality rate and patients with trauma's prognosis. The purpose of the current study was to assess the prognostic ability of various trauma scoring systems for patients' mortality and morbidity in cases involving chest and abdominal injuries, as they are common in the surgery department. Methodology At Ranchi, Jharkhand's Rajendra Institute of Medical Sciences, a prospective observational study was conducted from June 2021 to September 2022. All patients who met the requirements for inclusion were older than 18 and reported chest and abdominal trauma totaling 204. Before any essential therapies, primary care and resuscitation, including airway maintenance, breathing, circulation, and hemorrhage control, were established. A comprehensive clinical evaluation was done based on each patient's needs. Radiological evaluation included chest X-ray and ultrasonography (USG) for chest trauma, whereas USG (FAST) and CT scans were for abdominal trauma. Trauma scores, such as the Revised Trauma Score (RTS), the Trauma Revised Injury Severity Score (TRISS), the New Injury Severity Score (NISS), and the Injury Severity Score (ISS), were computed and examined using IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. Results Of the 204 patients, 14.7% were female and 85.3% were male. The age range of 21-30 years old accounted for the largest percentage of cases (28%). 50 percent of injuries were caused by automobile accidents, while 25% were the result of assaults. At 83.8% versus 16.2%, blunt injuries were substantially more common than penetrating ones. In comparison to the chest, the abdomen was more frequently involved. The study's findings demonstrated that, while every trauma scoring was statistically significant in predicting mortality, the New Injury Severity Score (NISS), as well as the Trauma Revised Injury Severity Score (TRISS), became the most effective in predicting mortality (p < 0.0001). Conclusion According to the results, the most precise trauma grading method for chest and abdominal injuries is the Trauma Revised Injury Severity Score (TRISS), even though all other trauma scoring systems are useful in predicting patient outcomes. Surgeons using these metrics to predict outcomes and make well-informed treatment decisions can benefit greatly.

ABSTRACTIntroduction:Trauma scoring systems are essential for predicting outcomes in trauma patients, guiding clinical decisions, and optimizing resource allocation. Common systems include the Injury Severity Score (ISS), New ISS (NISS), Revised Trauma Score (RTS), Trauma and ISS (TRISS), Emergency Trauma Score (EMTRAS), and Rapid Emergency Medicine Score (REMS). This study aims to evaluate the predictive accuracy of REMS and EMTRAS in comparison to traditional trauma scoring systems.Methods:This prospective observational study involved 1090 trauma patients admitted to the Department of Emergency Medicine from January 2021 to December 2023. Eligible patients were aged 18 or older with documented trauma. Data collection encompassed demographics, clinical parameters, and trauma severity, assessed using six scoring systems. Outcomes were monitored until patient discharge or death.Results:The cohort consisted of 915 (83.9%) male patients with a mean age of 36.1 years. Road traffic accidents were the leading cause of trauma, 934 (85.6%). Intensive care unit patients exhibited higher ISS and lower RTS scores (P < 0.0001), indicating more severe injuries. Nonsurvivors showed higher ISS and NISS and lower RTS and TRISS scores. EMTRAS demonstrated higher sensitivity and specificity than REMS, while TRISS proved the most effective in predicting trauma outcomes.Conclusions:REMS and EMTRAS had reasonable sensitivity and specificity but were less effective than traditional systems such as ISS, NISS, RTS, and TRISS. TRISS emerged as the most reliable tool for predicting outcomes, supporting its continued use as the gold standard in trauma assessment.

This study investigated the relationship between trauma scoring systems and outcomes in patients with severe traumatic brain injury (TBI). From January 2018 to June 2021, 1,122 patients with severe TBI were registered in the Korean Neuro-Trauma Data Bank System. Among them, 697 patients with data on trauma scoring systems were included in the study. According to the Glasgow Outcome Scale-Extended score, the patients were divided into unfavorable and favorable outcome groups. The abbreviated injury scale (AIS), injury severity score (ISS), revised trauma score (RTS), and trauma and injury severity score (TRISS) were evaluated. The AIS head score was higher in the unfavorable outcome group than in the favorable outcome group (4.39 vs. 4.06, p<0.001). ISS was also higher in the unfavorable outcome group (27.27 vs. 24.22, p=0.001). The RTS and TRISS were higher in the favorable outcome group (RTS, 4.74 vs. 5.45, p<0.001; TRISS, 48.05 vs. 71.02, p<0.001). In comparing the survival and death groups, the ISS was lower in the survival group (25.76 vs. 27.29, p=0.036). Furthermore, RTS was higher in the survival group (5.26 vs. 4.54, p<0.001), as was TRISS (62.11 vs. 44.91, p<0.001). Trauma scoring systems, including ISS, RTS, and TRISS, provide tools for quantifying posttraumatic risk and can be used to predict prognosis. Among these, TRISS is an indicator of the predicted survival rate and is considered a clinically useful tool for predicting unfavorable and favorable outcomes in patients with severe TBI.

Background: Easy-to-use trauma scoring systems can be used for making good clinical decision before the patient reaches the hospital and at emergency department. These scoring systems can also be used for timely delivering medical support and preparing the patient for surgery in early stage. The objective of this study was to assess the ability of trauma scoring systems such as the Glasgow Coma Scale (GCS), Injury Severity Score (ISS), and Revised Trauma Score (RTS) to predict outcomes in young children with traumatic injuries.&#x0D; Methods: This was a potential cross-sectional study that was conducted in the emergency department of Suez Canal University Hospitals. We included 86 children patients younger than 6 years of age who were presented to hospital via the emergency department with any traumatic injury and compared the trauma outcomes for GCS, ISS, and RTS on patient outcomes.&#x0D; Results: The main type of accident encountered in our study was fall from height (33.7%) followed by road traffic accidents (29.1%). Mortality rate in our study was 4.7%. The mean trauma scores of ISS, GCS, and RTS in our studied population were 11.47, 14.21, and 7.79, respectively. All trauma scores differed with statistical significance (p&lt;0.001, &lt;0.001, &lt;0.030, respectively) between the survivors and mortality groups. We found a mean ISS of 10.30 ± 5.84 in survived children and 35.25 ± 25.97 in those who died. Mean GCS was 14.62 ± 1.10in survivors and 5.75 ± 1.50 in non-survivors. RTS means were7.96 ± 0.33in survived children and 4.25 ± 0.50 in those who died, respectively. ROC curve analysis of the three scores regarding mortality prediction revealed close results; all showed a modest ability to predict mortality. The highest AUC was for RTS and GCS; 0.998 and 0.997, respectively. ISS had a slightly lower AUC of 0.0816. In the current study, RTS and GCS showed the best sensitivity and specificity to predict mortality of 100% and 98.78%, respectively. A slight lower ability was found for ISS with a sensitivity of75%. The desired cut-offs to predict mortality were ≤7 for the GCS, ≤5 for the RTS and ≥17 for the ISS with the previously mentioned sensitivity and specificity. Regarding the need for surgery, among survived patients, those who had surgery had statistically significant higher ISS compared to those who did not have surgery (14.69 ± 9.98 Vs 7.39 ± 6.04) (p&lt;0.001). On the other hand, there was no statistically significant difference between the two groups in regard to GCS (p=0.053) and RTS (p=0.251). Conclusion: In conclusion, we found that worse trauma scores of ISS, GCS, and RTS were associated with increased mortality and prolonged hospital stays among young children’s injuries. Among these three trauma scores, we found RTS and GCS to have the best predictive value. The cutoff values of ISS, GCS, and RTS for predicting mortality were &gt;17, ≤7, and ≤5, respectively.

BackgroundAbout 5.8 million people die each year as a result of injuries, and nearly 90% of these deaths occur in low and middle-income countries (LMIC). Trauma scoring is a cornerstone of trauma quality improvement (QI) efforts, and is key to organizing and evaluating trauma services. The objective of this review was to assess the appropriateness, feasibility, and QI applicability of traditional trauma scoring systems in LMIC settings.Materials and methodsThis systematic review searched PubMed, Scopus, CINAHL, and trauma-focused journals for articles describing the use of a standardized trauma scoring system to characterize holistic health status. Studies conducted in high-income countries (HIC) or describing scores for isolated anatomic locations were excluded. Data reporting a score’s capacity to discriminate mortality, feasibility of implementation, or use for QI were extracted and synthesized.ResultsOf the 896 articles screened, 336 were included. Over half of studies (56%) reported Glasgow Coma Scale, followed by Injury Severity Score (ISS; 51%), Abbreviated Injury Scale (AIS; 24%), Revised Trauma Score (RTS; 19%), Trauma and Injury Severity Score (TRISS; 14%), and Kampala Trauma Score (7%). While ISS was overwhelmingly predictive of mortality, 12 articles reported limited feasibility of ISS and/or AIS. RTS consistently underestimated injury severity. Over a third of articles (37%) reporting TRISS assessmentsobserved mortality that was greater than that predicted by TRISS. Several articles cited limited human resources as the key challenge to feasibility.ConclusionsThe findings of this review reveal that implementing systems designed for HICs may not be relevant to the burden and resources available in LMICs. Adaptations or alternative scoring systems may be more effective.PROSPERO registration numberCRD42017064600.

Objective: To list, describe and classify the extant trauma scoring systems found in the English language literature from the vantage of utility to emergency medicine. Each system is illustrated by a table and a hypothetical case study. Data Sources: Medline citations provided the data. The systems are classified as physiological, anatomical and combined trauma scoring systems. Results: We reviewed the Glasgow Coma Scale, the Paediatric Glasgow Coma Scale, the Trauma Score and Revised Trauma Score, the Circulation, Respiration, Abdominal/Thoracic, Motor and Speech Scale, the Acute Physiology and Chronic Health Evaluation System, Abbreviated Injury Scale, the Injury Severity Score, the Anatomical Profile, A Severity Characterization of Trauma, Revised Trauma Score and Injury Severity Score and its revisions, the Paediatric Trauma Score and the Drug‐Rock Injury Severity Score. Conclusions: This compendium should help emergency physicians become familiar with trauma scoring systems which evaluate the extent and severity of injuries, facilitate inter‐institutional comparisons and facilitate trauma research.

Objectives: The accuracy of the Injury Severity Score (ISS), New Injury Severity Score (NISS), Revised Trauma Score (RTS), and Trauma and Injury Severity Score (TRISS) in predicting mortality in cases of geriatric trauma is investigated in this study. Design: The study was designed as a prospective observational study. Materials and Methods: This was a prospective observational study of 200 elderly trauma patients admitted to a tertiary care hospital over an 18-month period. Data were collected from each patient on the day of admission in order to compute the ISS, NISS, RTS, and TRISS. Results: The average age of the patients was 66.35 years. The most common mechanism of injury (94.0 percent) was a traffic accident, with a mortality rate of 17.0 percent. The predictive accuracies of the ISS, NISS, RTS, and TRISS for mortality prediction were compared using receiver operator characteristic (ROC) curves. &nbsp;The Best cut-off points for predicting mortality in elderly trauma patient using TRISS system was a score of 91.6 (sensitivity 97%, specificity of 88%, area under ROC curve 0.972), similarly cut-off point under the NISS was score of 17(91%, 93%, 0.970); for ISS best cut-off point was at 15(91%, 89%, 0.963) and for RTS it was 7.108(97%,80%,0.947). There were statistical differences among ISS, NISS, RTS and TRISS in terms of area under the ROC curve (p &lt;0.0001). Conclusion: When compared to the ISS, NISS, and RTS, TRISS was the strongest predictor of mortality in elderly trauma patients.

Introduction The purpose of this study was to examine the capacity of commonly used trauma scoring systems such as the Glasgow Coma Scale (GCS), Injury Severity Score (ISS), and Revised Trauma Score (RTS) to predict outcomes in young children with traumatic injuries. Methods This retrospective study was conducted for the period from 2009 to 2016 in Kaohsiung Chang Gung Memorial Medical Hospital, a level I trauma center. We included all children under the age of 6 years admitted to the hospital via the emergency department with any traumatic injury and compared the trauma scores of GCS, ISS, and RTS on patients' outcome. The primary outcomes were mortality and prolonged Intensive Care Unit (ICU) stay, with the latter defined as an ICU stay longer than 14 days. The secondary outcome was the hospital length of stay (HLOS). Receiver operating characteristic (ROC) analysis was also adopted with the value of the area under the ROC curve (AUC) for comparing trauma score prediction with patient mortality. Cutoff values from each trauma score for mortality prediction were also measured by determining the point along the ROC curve where Youden's index was maximum. Results We included a total of 938 patients in this study, with a mean age of 3.1 ± 1.82 years. The mortality rate was 0.9%, and 93 (9.9%) patients had a prolonged ICU stay. An elevated ISS (34 ± 19.9 vs. 5 ± 5.1, p=0.004), lower GCS (8 ± 5.0 vs. 15 ± 1.3, p=0.006), and lower RTS (5.58 ± 1.498 vs. 7.64 ± 0.640, p=0.006) were all associated with mortality. All three scores were considered to be independent risk factors of mortality and prolonged ICU stay and had a linear correlation with increased HLOS. With regard to predicting mortality, ISS has the highest AUC value (ISS: 0.975; GCS: 0.864; and RTS: 0.899). The prediction cutoff values of ISS, GCS, and RTS on mortality were 15, 11, and 7, respectively. Conclusion Regarding traumatic injuries in young children, worse ISS, GCS, and RTS were all associated with increased mortality, prolonged ICU stay, and longer hospital LOS. Of these scoring systems, ISS was the best at predicting mortality.

Objective: To list, describe and classify the extant trauma scoring systems found in the English language literature from the vantage of utility to emergency medicine. Each system is illustrated by a table and a hypothetical case study. Data Sources: Medline citations provided the data. The systems are classified as physiological, anatomical and combined trauma scoring systems. Results: We reviewed the Glasgow Coma Scale, the Paediatric Glasgow Coma Scale, the Trauma Score and Revised Trauma Score, the Circulation, Respiration, Abdominal/Thoracic, Motor and Speech Scale, the Acute Physiology and Chronic Health Evaluation System, Abbreviated Injury Scale, the Injury Severity Score, the Anatomical Profile, A Severity Characterization of Trauma, Revised Trauma Score and Injury Severity Score and its revisions, the Paediatric Trauma Score and the Drug-Rock Injury Severity Score. Conclusions: This compendium should help emergency physicians become familiar with trauma scoring systems which evaluate the extent and severity of injuries, facilitate inter-institutional comparisons and facilitate trauma research.

Introduction: Trauma scoring systems in prehospital settings are supposed to ensure the most appropriate in-hospital treatment of the injured. Aim of the study: To determine the sensitivity and specificity of the CRAMS scale (circulation, respiration, abdomen, motor and speech), RTS score (revised trauma score), MGAP (mechanism, Glasgow Coma Scale, age, arterial pressure) and GAP (Glasgow Coma Scale, age, arterial pressure) scoring systems in prehospital settings in order to evaluate trauma severity and to predict the outcome. Materials and Methods: A prospective, observational study was conducted. For every trauma patient, a questionnaire was initially filled in by a prehospital doctor and these data were subsequently collected by the hospital. Results: The study included 307 trauma patients with an average age of 51.7 ± 20.9. Based on the ISS (injury severity score), severe trauma was diagnosed in 50 (16.3%) patients. MGAP had the best sensitivity/specificity ratio when the obtained values indicated severe trauma. The sensitivity and specificity were 93.4 and 62.0%, respectively, for an MGAP value of 22. MGAP and GAP were strongly correlated with each other and were statistically significant in predicting the outcome of treatment (OR 2.23; 95% Cl 1.06–4.70; p = 0.035). With a rise of one in the MGAP score value, the probability of survival increases 2.2 times. Conclusion: MGAP and GAP, in prehospital settings, had higher sensitivity and specificity when identifying patients with a severe trauma and predicting an unfavorable outcome than other scoring systems.

Objective: This study aimed to evaluate the effectiveness of various trauma scoring systems in predicting mortality in pediatric patients with multiple trauma and to determine their cut-off values. Materials and Methods: A methodological study was conducted on pediatric patients under 18 years of age admitted to the pediatric intensive care unit for multiple trauma. Demographic data, clinical parameters, and trauma scores, including the Revised Trauma Score (RTS), Pediatric Trauma Score (PTS), Glasgow Coma Scale (GCS), Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), Pediatric Risk of Mortality Score III (PRISM-3), and Pediatric Logistic Organ Dysfunction (PELOD-2), were collected and analyzed. Results: Among the 107 patients, there were 15 deaths (14%). Significant differences were observed between survivors and non-survivors in all trauma scores. Non-survivors had higher AIS, ISS, PRISM-3, and PELOD-2 scores, while survivors had higher PTS, RTS, and GCS scores (P < .001). In the multivariate binary logistic regression analysis, both ISS (odds ratio [OR] 1.060 [95% CI: 1.029-1.092], P < .001) and RTS (OR 0.059 [95% CI: 0.007-0.517], P =.011) were independently associated with mortality. Injury Severity Score demonstrated the highest area under the curve (AUC) value of 0.98 in the receiver operating characteristic (ROC) analysis. Conclusion: Both ISS and RTS were identified as independent predictors of mortality in pediatric trauma patients. Injury Severity Score was the strongest predictor, while RTS also provided significant prognostic value. Integration of these scores into early assessment may enhance risk stratification and support clinical decision-making in pediatric trauma care.