Development and validation of a new simplified anatomic trauma mortality score

Area of Science:

• Trauma Surgery
• Emergency Medicine
• Public Health

Background:

• Existing trauma mortality prediction scores like GAP and mGAP lack validation in low- and middle-income countries, including Malaysia.
• Physiological parameters influencing current scores are subject to fluctuation, potentially reducing accuracy in diverse clinical settings.
• There is a need for a simplified, anatomically focused trauma scoring system tailored to the Malaysian population.

Purpose of the Study:

• To develop and validate a novel, simplified anatomic trauma scoring system for Malaysian trauma patients.
• To compare the predictive accuracy of the new score against existing systems like GAP and mGAP.

Main Methods:

• Retrospective analysis of 3825 trauma patients from the Hospital Sultanah Aminah Trauma Surgery Registry (2011-2016).
• Patients were divided into development (n=2683) and validation (n=1142) cohorts.
• Univariate and multivariable logistic regression identified significant anatomic predictors for mortality, forming the basis of the new score.

Main Results:

• The HeCLLiP (Head, cervical spine, lung, liver, pelvic fracture) score incorporates five key anatomic components.
• In validation samples, HeCLLiP achieved an area under the ROC curve of 0.802, comparable to GAP (0.825) and mGAP (0.806).
• A cut-off value of (>2) for the HeCLLiP score demonstrated a sensitivity of 79.2% and specificity of 70.6%.

Conclusions:

• The HeCLLiP score is a simplified, anatomically based tool suitable for the Malaysian trauma population.
• It demonstrates good predictive ability for trauma mortality, offering a practical alternative to more complex scores.
• This score can aid in risk stratification and resource allocation for trauma patients in Malaysia.