Accuracy and External Validation of mREMS in Road Traffic Injuries

Can the Modified Rapid Emergency Medicine Score (mREMS) Predict Trauma Patients' Outcomes in a Deteriorated Health System After Decades of Conflict?

The goal of this prospective observational study is to assess the accuracy and external validation of the Modified Rapid Emergency Medicine Score (mREMS) in predicting outcomes for patients with road traffic injuries (RTIs) admitted to the emergency department of a hospital in Baghdad.

The main questions it aims to answer are:

How accurate is the mREMS in predicting the prognosis of road traffic injury patients? Does the mREMS provide reliable predictive value in a local context, specifically in Baghdad?

Participants will:

Be assessed using the mREMS upon admission to the emergency department. Have their clinical outcomes, including mortality, need for surgery, and length of stay, monitored throughout their hospital stay.

Road traffic injuries (RTIs) are one of the leading causes of morbidity and mortality globally, disproportionately affecting low- and middle-income countries such as Iraq. Accurate and standardized clinical tools are essential for triaging patients and improving clinical outcomes in resource-limited emergency departments. Emergency departments play a central role in the timely assessment and management of RTI patients. The Modified Rapid Emergency Medicine Score (MREMS) has emerged as a valuable tool for predicting in-hospital mortality and other critical outcomes in emergency settings. The Modified Rapid Emergency Medicine Score (mREMS) evaluates key physiological parameters, including age, heart rate, respiratory rate, oxygen saturation, mean arterial pressure, and the Glasgow Coma Scale (GCS), to provide a rapid and standardized assessment of injury severity.

Validation studies in Thailand and other regions have demonstrated mREMS's reliability in predicting in-hospital mortality and critical care needs. These studies have used performance metrics such as sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) to assess the tool's predictive accuracy. Despite these advancements, there remains a lack of validation studies in Iraq, where healthcare systems face unique challenges, including poor road safety and under-resourced emergency departments.

Previous studies emphasize the importance of adapting and validating scoring systems for specific populations. In Baghdad, RTIs are a significant public health burden, but no standardized tools like mREMS have been validated in this context. This study aims to address this gap by evaluating mREMS's performance in predicting mortality, morbidity, ICU admission, and length of hospital stay requirements in RTI patients in a Baghdad hospital. The findings will contribute to improving trauma care and inform the adaptation of standardized scoring systems in Iraq.

Inclusion Criteria:

• Written informed consent provided by the patient or a legal representative (if the patient is unconscious or unable to provide consent).
• Patients presenting to the emergency department within 4 hours of the injury.
• Availability of complete physiological data for MREMS calculation.
• Patients whose clinical outcomes (e.g., mortality, length of hospital stay, need for intensive care) are available for follow-up and analysis.

Exclusion Criteria:

• Pregnant women, due to the potential risk involved in the study and unique considerations in trauma care.
• Patients with pre-existing severe chronic conditions (e.g., end-stage renal disease, terminal cancer) that could severely affect outcomes.
• Patients who were transferred from another hospital.
• Incomplete or missing data for mREMS parameters.
• Patients who leave against medical advice (LAMA) or are discharged before outcome data can be collected.