Application of New Trauma Scoring Systems for Mortality Prediction in Patients with Adult Major Trauma

ABSTRACT

PURPOSE: Various scoring systems have been introduced in grading severity and predicting mortality of trauma patients. The objective of this study is to apply novel trauma scoring systems; BIG score (Base deficit (B), International normalized ratio (I), Glasgow Coma Scale (G)), Emergency Trauma Score (EMTRAS), Probability of Survival score version 12 (PS12), and MGAP (Mechanism, GCS, Age, Arterial pressure) to adults with major trauma, and to compare their performance with traditional systems; Injury Severity System (ISS), Revised Trauma Score (RTS), and Trauma and Injury Severity Score (TRISS). METHODS: Retrospective data collected between January 2011 and June 2012 from a regional trauma center registry on adult major trauma patients (Age> or =18, ISS> or =16) were used to identify factors associated with death. Univariate associations were calculated, and a multiple logistic regression analysis was used to determine variables associated with hospital mortality. RESULTS: A total of 298 adult major trauma patients were retrieved in order to validate new trauma scoring systems. The median ISS was 22 [interquartile range (IQR) 17~25], and the hospital mortality rate was 30.9%. Traditional trauma scoring systems were each calculated to have an area under the curve of ISS 0.72 [95% confidence interval (CI) 0.67-0.77], TRISS 0.91 (95% CI 0.88-0.94), and RTS 0.90 (95% CI 0.86-0.93). New trauma scoring systems were calculated to have an area under the curve of EMTRAS 0.91 (95% CI 0.87-0.94), BIG score 0.90 (95% CI 0.86-0.93), PS12 0.91 (95% CI 0.87-0.94), and MGAP 0.89 (95% CI 0.85-0.93). CONCLUSION: The new trauma scoring systems (EMTRAS, BIG, MGAP) were good predictors of mortality in adult major trauma patients on admission. They performed well compared to traditional trauma scoring systems (ISS, RTS, TRISS).