Comparing the predictive values of GAP, NTS, RTS, and KTS indicators in determining the hospital outcome of multi-trauma patients admitted to Imam Khomeini hospital in Urmia, Iran

Document Type : Original Article

Authors

1 Assistant Professor of Emergency Medicine, Urmia University of Medical Sciences, Urmia, Iran

2 General physician, Urmia University of Medical Sciences, Urmia, Iran

Abstract

Background: Trauma is one of the main causes of premature deaths worldwide. Improvements in hospital and pre-hospital care and procedures can reduce trauma-related deaths. Easy trauma scoring systems can help the doctors to adopt a specific and appropriate method of managing trauma patients.
Objectives: This study aimed to compare the degree to which indicators of GCS, Age, and systolic blood pressure (GAP), New trauma score (NTS), Revised trauma score (RTS), and Kampala trauma score (KTS) predicted the hospital outcome of the multi-trauma patients.
Methods: This descriptive-analytical study was conducted on 385 multi-trauma patients referred to the emergency department of Imam Khomeini hospital in Urmia (Iran). The data related to GAP, NTS, RTS, and KTS were collected using a checklist and then were analyzed using descriptive and analytical statistics by SPSS 18.
Results: The mean RTS, NTS, KTS, GAP and GCS values were 6.71±0.47, 6.06±0.34, 8.25±0.96, 77.77±0.96, 22.20±2 and 13.90±1.8, respectively. Moreover, the deceased patients’ averages of RTS, NTS and GAP were significantly lower than these averages in the discharged patients. Nonetheless, there was no significant difference between deceased and discharged patients in terms of their average KTS. Moreover, there was no statistically significant difference between the average RTS, NTS, KTS and GAP of the patients who needed surgery and the patients who did not need surgery. In addition, the averages RTS, NTS and GAP of the patients who needed ICU were significantly lower than these averages in patients who did not need ICU. However, there was no significant difference between the average KTS of the patients who needed ICU and the patients who did not need ICU.
Conclusion: The findings of the study show that the deceased trauma patients’ RTS, NTS, KTS and GAP were lower than the recovered patients’ RTS, NTS, KTS and GAP. This problem can be a risk factor and shows that there is a need for faster treatment of these patients.

Keywords


  1. Pfeifer R, Teuben M, Andruszkow H, Barkatali BM, Pape HC. Mortality patterns in patients with multiple trauma: a systematic review of autopsy studies. PloS One. 2016;11(2):e0148844. doi:10.1371/journal.pone.0148844 PMid:26871937 PMCid:PMC4752312
  2. Halvachizadeh S, Teuber H, Berk T, Allemann F, von Känel R, Zelle B, et al. Prevalence, injury-, and non-injury-related factors associated with anxiety and depression in polytrauma patients-A retrospective 20 year follow-up study. Plos One. 2020;15(5): e0232678. doi:10.1371/journal.pone.0232678 PMid:32365087 PMCid:PMC7197792
  3. Rapsang AG, Shyam DC. Scoring systems of severity in patients with multiple trauma. Cirugía Española (English Edition). 2015; 93(4):213-21. doi:10.1016/j.cireng.2013.12.031
  4. Lefering R. Trauma score systems for quality assessment. Eur J Trauma. 2002;28:52-63. doi:10.1007/s00068-002-0170-y
  5. Champion H. Trauma scoring. Scand J Surg. 2002;1 (91):22-12 doi:10.1177/145749690209100104 PMid:12075830
  6. Mazloomy Mahmoodabad SS, Zeidabadi B, Rajabalipour MR. Predicting Iranian road accidents: application of the theory of planned behavior. Int Arch Health Sci. 2023; 10(4): 186-192. doi: 10.48307/iahsj.2023.404891.1000
  7. Orhon R, Eren Ş, Karadayi Ş, Korkmaz İ, Coşkun A, Eren M, et al. Comparison of trauma scores for predicting mortality and morbidity on trauma patients. Ulusal Travma Ve Acil Cerrahi Dergisi-Turkish J Trauma Emerg Surg. 2014; 20 (4) doi:10.5505/tjtes.2014.22725 PMid:25135020
  8. Alvarez BD, Razente D, Lacerda DA, Lother NS, Von-Bahten LC, Stahlschmidt C, et al. Analysis of the Revised Trauma Score (RTS) in 200 victims of different trauma mechanisms. Revista do Colégio Brasileiro de Cirurgiões. 2016;43:334-40. doi:10.1590/0100-69912016005010 PMid:27982326
  9. Lichtveld R, Spijkers AT, Hoogendoorn J, Panhuizen I, van der Werken C. Triage Revised Trauma Score change between first assessment and arrival at the hospital to predict mortality. Int J Emerg Med. 2008;1(1):21-6. doi:10.1007/s12245-008-0013-7 PMid:19384497 PMCid:PMC2536180
  10. Toschlog EA, MacElligot J, Sagraves SG, Schenarts PJ, Bard MR, Goettler CE, et al. The relationship of Injury Severity Score and Glasgow Coma Score to rehabilitative potential in patients suffering traumatic brain injury. Am Surg. 2003; 69 (6):491-8. doi:10.1177/000313480306900607 PMid:12852506
  11. Jeong JH, Park YJ, Kim DH, Kim TY, Kang C, Lee SH, et al. The new trauma score (NTS): a modification of the revised trauma score for better trauma mortality prediction. BMC Surg. 2017; 17:1-9. doi:10.1186/s12893-017-0272-4 PMid:28673278 PMCid:PMC5496419
  12. Mohammadi J, Nabiamjad R, Amiri S. Evaluation of emotional intelligence and its relationship with job stress and the symptoms of post-traumatic stress disorder among Shiraz pre-hospital emergency technicians in 2020. Int Arch Health Sci. 2023; 10(2): 84-90. doi: 10.48307/iahsj.2023.176367
  13. Weeks SR, Stevens KA, Haider AH, Efron DT, Haut ER, MacKenzie EJ, et al. A modified Kampala trauma score (KTS) effectively predicts mortality in trauma patients. Injury. 2016;47 (1):125-9. doi:10.1016/j.injury.2015.07.004 PMid:26256783
  14. Ahun E, Köksal Ö, Sığırlı D, Torun G, Dönmez SS, Armağan E. Value of the Glasgow Coma Scale, age, and arterial blood pressure (GAP) score for predicting the mortality of major trauma patients presenting to the emergency department. Turk J Trauma Emerg Surg. 2014;2(4).241-7 doi:10.5505/tjtes.2014.76399 PMid:25135017
  15. NR C, Dave P, PN S, CA S. Comparison of Kampala Trauma Score and Trauma Injury Severity Score in Predicting Mortality in Trauma Patients. Trauma Mon. 2023;28(4):859-66.
  16. Kimura A, Tanaka N. Reverse shock index multiplied by Glasgow Coma Scale score (rSIG) is a simple measure with high discriminant ability for mortality risk in trauma patients: an analysis of the Japan Trauma Data Bank. Crit Care. 2018; 22 (1):1-7. doi:10.1186/s13054-018-2014-0 PMid:29642920 PMCid:PMC5896075
  17. Rahmani F, Ebrahimi Bakhtavar H, Shams Vahdati S, Hosseini M, Mehdizadeh Esfanjani R. Evaluation of MGAP and GAP trauma scores to predict prognosis of multiple-trauma patients. Trauma Mon. 2017;22(3) doi:10.5812/traumamon.33249
  18. Ainy E, Soori H, Ganjali M, Baghfalaki T. Eliciting road traffic injuries cost among Iranian drivers' public vehicles using willingness to pay method. Int J Crit Illn Injury Sci. 2015;5(2): 108. doi:10.4103/2229-5151.158412 PMid:26157655 PMCid:PMC4477387
  19. Nirula R, Maier R, Moore E, Sperry J, Gentilello L. Scoop and run to the trauma center or stay and play at the local hospital: hospital transfer's effect on mortality. J Trauma Acute Care Surg. 2010;69 (3):595-601. doi:10.1097/TA.0b013e3181ee6e32 PMid:20838131
  20. Kondo Y, Abe T, Kohshi K, Tokuda Y, Cook EF, Kukita I. Revised trauma scoring system to predict in-hospital mortality in the emergency department: Glasgow Coma Scale, Age, and Systolic Blood Pressure score. Crit Care. 2011;15:1-8. doi:10.1186/cc10348 PMid:21831280 PMCid:PMC3387633
  21. Akhavan Akbari Gh, Mohammadian A. Comparison of the RTS and ISS scores on prediction of survival chances in multiple trauma patients. Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca. 2012;79(6):535-9. doi:10.55095/achot2012/078
  22. Khosravi A, Ebrahimi H. To evaluate the outcomes of patients with truma admitted to the imam hossein hospital, shahrood using the trauma and injury severity score (TRISS). Iran J Epidemiol. 2008;2(8):35-41
  23. Garkaz O, Salari Lak S, Mehryar H, Khalkhali H. Study ending of hospitalized traffic accidents injured in Urmia Imam Khomeini hospital by using TRISS method. Iran J Forensic Med. 2019;24 (4):23-9