Utilizing injury severity score, Glasgow coma scale, and revised trauma score for trauma-related in-hospital mortality and ICU admission prediction; originated from 7-year results of a nationwide multicenter registry

Armin  Khavandegar; Vali  Baigi; Mohammadreza  Zafarghandi; Vafa  Rahimi-Movaghar; Esmaeil  Fakharian; Seyed Houssein  Saeed-Banadaky; Vahid  Hoseinpour; Homayoun  Sadeghi-Bazargani; Akram  Zolfaghari Sadrabad; Salman  Daliri; Mehdi Nasr Isfahani; Vahid  Rahmanian; Morteza  Hemmat; Rahim  Aali; Mohamad  Kogani; Sobhan  Pourmasjedi; Seyed Mohammad  Piri; Sara  Mirzamohamadi; Mahgol Sadat  Hassan Zadeh Tabatabaei; Khatereh  Naghdi; Payman Salamati

doi:10.18502/fem.v8i3.16329

Armin Khavandegar Sina Trauma and Surgery Research Center, Tehran University of Medical Science, Tehran, Iran.
Vali Baigi Sina Trauma and Surgery Research Center, Tehran University of Medical Science, Tehran, Iran.
Mohammadreza Zafarghandi Sina Trauma and Surgery Research Center, Tehran University of Medical Science, Tehran, Iran.
Vafa Rahimi-Movaghar Sina Trauma and Surgery Research Center, Tehran University of Medical Science, Tehran, Iran.
Esmaeil Fakharian Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran.
Seyed Houssein Saeed-Banadaky Trauma Research Center, Rahnemoon Hospital, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Vahid Hoseinpour Department of Emergency Medicine, school of Medicine, Urmia University of Medical Sciences, Urmia, Iran.
Homayoun Sadeghi-Bazargani Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
Akram Zolfaghari Sadrabad Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Salman Daliri Clinical Research Development Unit, Imam Hossein Hospital, Shahroud University of Medical Sciences, Shahroud, Iran.
Mehdi Nasr Isfahani Department of Emergency Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Vahid Rahmanian Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran.
Morteza Hemmat Saveh University of Medical Sciences, Saveh, Iran.
Rahim Aali Department of Environmental Health, School of Health Research Center for Environmental Pollutants, Qom University of Medical Sciences, Qom, Iran.
Mohamad Kogani Abadan University of Medical Sciences, Abadan, Iran.
Sobhan Pourmasjedi Sina Trauma and Surgery Research Center, Tehran University of Medical Science, Tehran, Iran.
Seyed Mohammad Piri Sina Trauma and Surgery Research Center, Tehran University of Medical Science, Tehran, Iran.
Sara Mirzamohamadi Sina Trauma and Surgery Research Center, Tehran University of Medical Science, Tehran, Iran.
Mahgol Sadat Hassan Zadeh Tabatabaei Sina Trauma and Surgery Research Center, Tehran University of Medical Science, Tehran, Iran.
Khatereh Naghdi Sina Trauma and Surgery Research Center, Tehran University of Medical Science, Tehran, Iran.
Payman Salamati Sina Trauma and Surgery Research Center, Tehran University of Medical Science, Tehran, Iran.

DOI: https://doi.org/10.18502/fem.v8i3.16329

Keywords: Glasgow Coma Scale; Multiple Trauma; Patient Outcome Assessment; Prediction Model; Severity Scores; Trauma Registry; Wound and Injuries

Abstract

Objective: During the past few decades, many scoring systems have been developed to evaluate the severity of injury and predict the outcome in trauma patients. This study aimed to assess the capacity of three common trauma scoring systems: injury severity score (ISS), Glasgow coma scale (GCS), and revised trauma score (RTS) in predicting in-hospital mortality and ICU admission in patients with traumatic injury.

Methods: This is a multicenter study of the hospital-based national trauma registry of Iran (NTRI), an ongoing registry-based trauma database. This study included trauma cases from 12 major trauma centers throughout the country admitted between July 2016 and November 2023. The inclusion criteria were all patients admitted to the emergency department due to trauma, hospitalized for at least 24 hours, deceased within the first 24 hours of admission, and patients transferred from the intensive care unit (ICU)s of other hospitals.

Results: A total of 50,458 traumatic patients, with 38,740 (76.9%) being male, were included in this study. After adjustment for confounders, head, face, and neck injuries were associated with the highest odds of death (OR: 7.51, P-value<0.001), whereas abdominal injuries were associated with the highest odds of ICU admission (OR: 4.58, P-value<0.001). Each Unit increase in RTS score was accompanied by a 61% decrease in odds of death (OR: 0.39, P-value<0.001). The area under the ROC curve for predicting in-hospital mortality was 0.81 (0.79 to 0.82) in ISS, 0.78 (0.77 to 0.80) in GCS, and 0.75 (0.73 to 0.76) in RTS. There was a significant difference between RTS and GCS, as well as RTS and ISS for in-hospital mortality prediction (P-values< 0.001). The area under the ROC curve for the prediction of ICU admission was 0.75 (0.74 to 0.75) in ISS, 0.63 (0.62 to 0.63) in GCS, and 0.62 (0.61 to 0.63) in RTS. There was a statistically significant difference between ISS and GCS, as well as ISS and RTS, for ICU admission prediction (P-value<0.001).

Conclusion: ISS is the best predictor of in-hospital mortality and ICU admission, compared to GCS and RTS.