Mortality prediction in firearm injuries: Comparative performance of GCS, GAP, RTS, and lactate/hematocrit ratio

To compare the predictive performance of Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), GAP score, and lactate-hematocrit ratio for in-hospital mortality in patients with firearm injuries.

This retrospective cohort study included 204 patients with firearm injuries admitted to the emergency department between January 1, 2013, and December 31, 2022. Patients with missing lactate data (n = 285) or those who refused treatment (n = 43) were excluded. Receiver operating characteristic (ROC) analysis was used to compare Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), GAP score, and lactate-hematocrit ratio for predicting in-hospital mortality. Patients were categorized based on their GCS scores into GCS = 15 and GCS < 15. The predictive performance for mortality was analyzed separately for each group.

Among 204 patients, 25 (12.3 %) died. In the overall population, RTS (AUC = 0.953), GCS (AUC = 0.950), and GAP score (AUC = 0.946) exhibited excellent discriminative ability, and the lactate/hematocrit ratio (AUC = 0.780) exhibited good discriminative ability. But in the GCS = 15 subgroup, lactate-hematocrit ratio demonstrated superior predictive performance (AUC = 0.855) compared to the GAP score (AUC = 0.517) and the RTS score (AUC = 0.594).

Our study demonstrates that while RTS, GCS, and GAP score remain powerful predictors overall, the lactate-hematocrit ratio emerges as the most reliable risk assessment tool, specifically in firearm injury patients with a GCS of 15.