Comparison of RTS and MGAP Scores in Predicting Outcomes of Trauma Patients

Mortality Prediction in Multiple Trauma Patients: A Comparison of the Revised Trauma Score and MGAP Score at a Trauma Center

The goal of this prospective cohort study is to compare the predictive accuracy of the Revised Trauma Score (RTS) and the MGAP score in determining clinical outcomes among multiple trauma patients hospitalized at a trauma center in Iraq.

The main questions it aims to answer are:

Which score, RTS or MGAP, provides a more accurate prediction of clinical outcomes, including mortality? Are there specific subgroups of trauma patients where one scoring system outperforms the other?

Participants will:

Be assessed using both the RTS and MGAP scores upon admission. Have their clinical outcomes, including mortality and other relevant indicators, monitored throughout their hospital stay.

Trauma is one of the top four causes of mortality in developing countries and the second leading cause of death among the youth in these countries, as well as being the primary cause of year of life lost (YLL). Trauma represents a significant public health issue all over the world. With the progress of scientific and technological advancements and the industrialization of societies over the past century, trauma and its associated complications have emerged as the leading contributors to mortality and disability among individuals aged 1 to 44. Trauma represents a time-sensitive condition. Proper and effective management of trauma patients in both pre-hospital and hospital settings contributes to reducing mortality and preventing complications. The primary objectives in managing trauma patients include the rapid assessment of critically ill individuals, establishing treatment priorities, and delivering suitable care services.

Throughout the years, the rates of mortality due to trauma in Iraq have varied greatly because of different conflict-related influences. At the onset of the Iraq War in 2003, the case fatality rate (CFR) stood at approximately 20.4%, but by 2017 it had dropped to around 10.1%, indicating better survival outcomes among injured individuals. A study that examined combat-related fatalities from 2003 to 2006 found that although the monthly death count had doubled, the overall CFR stayed constant.

Scoring systems have been classically classified as anatomical, physiological, or combined scoring systems. The AIS, ISS, and NISS represent anatomical scoring systems that utilize various anatomical factors, such as the site and intensity of injuries. In contrast, the GCS, RTS, and PHI are physiological scoring systems that can be derived from data obtained during physical examinations. Additionally, the TRISS, NTRISS, and a TRISS are combined scoring systems that incorporate both anatomical and physiological characteristics of trauma.

The revised trauma score (RTS) is a physiological scoring system employed to assess trauma patients. Initially developed and assessed through a study involving over 2,000 individuals (10), the RTS incorporates three key physiological indicators: the Glasgow coma scale (GCS), systolic blood pressure (SBP), and respiration rate (RR). In addition, MGAP is primarily a physiological score that has been developed to predict survival outcomes in individuals experiencing trauma. Although it has been validated in research settings, it remains underutilized in low- and middle-income regions, despite its promise and practicality. The acronym MGAP represents the mechanism of injury (M), the Glasgow Coma Scale (G) score, the patient's age (A), and the systolic blood pressure (P). This score has previously been validated in France for its ability to predict 30-day mortality.

Inclusion Criteria:

• Presentation to the trauma center within 6 hours of injury.
• Availability of complete clinical and demographic data for scoring using RTS and MGAP.
• Patients who consent to participate in the study or whose legal representatives provide consent.
• Capability to assess outcomes such as survival, ICU admission, and complications.

Exclusion Criteria:

• Patients who expired before scoring or evaluation
• Missing or unreliable medical data for RTS or MGAP score calculations.
• Transfers from other facilities with interventions that could impact RTS or MGAP reliability.
• Pregnant patients, due to the unique considerations of trauma in pregnancy.