Scoring severity in trauma: comparison of prehospital scoring systems in trauma ICU patients.

Abstract

We evaluated the predictive ability of mechanism, Glasgow coma scale, age and arterial pressure (MGAP), Glasgow coma scale, age and systolic blood pressure (GAP), and triage-revised trauma Score (T-RTS) scores in patients from the Spanish trauma ICU registry using the trauma and injury severity score (TRISS) as a reference standard. Patients admitted for traumatic disease in the participating ICU were included. Quantitative data were reported as median [interquartile range (IQR), categorical data as number (percentage)]. Comparisons between groups with quantitative variables and categorical variables were performed using Student's T Test and Chi Square Test, respectively. We performed receiving operating curves (ROC) and evaluated the area under the curve (AUC) with its 95% confidence interval (CI). Sensitivity, specificity, positive predictive and negative predictive values and accuracy were evaluated in all the scores. A value of p<0.05 was considered significant. The final sample included 1361 trauma ICU patients. Median age was 45 (30-61) years. 1092 patients (80.3%) were male. Median ISS was 18 (13-26) and median T-RTS was 11 (10-12). Median GAP was 20 (15-22) and median MGAP 24 (20-27). Observed mortality was 17.7% whilst predicted mortality using TRISS was 16.9%. The AUC in the scores evaluated was: TRISS 0.897 (95% CI 0.876-0.918), MGAP 0.860 (95% CI 0.835-0.886), GAP 0.849 (95% CI 0.823-0.876) and T-RTS 0.796 (95% CI 0.762-0.830). Both MGAP and GAP scores performed better than the T-RTS in the prediction of hospital mortality in Spanish trauma ICU patients. Since these are easy-to-perform scores, they should be incorporated in clinical practice as a triaging tool.