Comparison of Injury Severity Score, Glasgow Coma Scale and Revised Trauma Score in Predicting the Outcome in Young Patients with Trauma Attending Emergency Department of Suez Canal University Hospitals

Abstract

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.
 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.
 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<0.001, <0.001, <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<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 >17, ≤7, and ≤5, respectively.