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

Abstract

Purpose: 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. Methods: 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. Results: 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). Conclusions: 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.