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Predictive value of trauma scoring systems for mortality and intensive care outcomes among trauma patients: a study
Naeimeh Heiranizadeh1, Marzieh Azimizadeh2, Seyedeh Mehrnoosh Mirvakili1
1Department of Surgery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Background:
Rapid and accurate assessment of trauma severity is essential for guiding clinical decisions and improving patient outcomes. Although several trauma scoring systems exist, their practicality and predictive performance in real-world emergency settings remain under investigation. This study aimed to evaluate and compare the predictive value of three rapidly assessable trauma scoring systems, the Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), and Injury Severity Score (ISS), for in-hospital mortality, intensive care unit (ICU) admission, and prolonged ICU stay among trauma patients in central Iran.
Methods:
This retrospective study analyzed 1,812 trauma patients admitted to Shahid Rahnemoun Hospital, Yazd, Iran, from April 2018 to May 2019. Demographic, clinical, and outcome data were collected from medical records. Logistic regression and receiver operating characteristic (ROC) curve analyses were used to assess the predictive performance of GCS, RTS, and ISS for trauma outcomes.
Results:
Road traffic injuries (RTIs) were the leading cause of trauma (60.6%), followed by falls (23.2%). The overall mortality rate was 1.6%, and 15.9% required ICU admission. ISS showed the strongest association with mortality (OR = 1.15; 95% CI: 1.10-1.20; p < 0.01), ICU admission (OR = 1.26; 95% CI: 1.23-1.30), and prolonged ICU stay (OR = 1.16; 95% CI: 1.13-1.20). ROC analysis confirmed ISS as the most accurate predictor across all outcomes: AUC = 0.948 (95% CI: 0.92-0.97) for mortality, 0.877 (95% CI: 0.85-0.90) for ICU admission, and 0.933 (95% CI: 0.91-0.95) for prolonged ICU stay. GCS and RTS also demonstrated acceptable predictive ability, particularly for prolonged ICU stay (AUC = 0.906 and 0.882, respectively).
Conclusion:
ISS exhibited superior predictive accuracy for mortality, ICU admission, and prolonged ICU stay compared with GCS and RTS. All three systems proved clinically useful, with ISS recommended for well-equipped trauma centers and GCS/RTS for rapid triage in resource-limited settings.