Prediction of mortality risk in patients with traffic injury: A case study in tabriz hospitals, Iran


1 Department of Health Services Management, Faculty of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran

2 Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

3 Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran

4 Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iran


Background: Trauma caused by traffic accidents is one of the main causes of mortality in the world. The trauma is a time-dependent condition. Trauma scoring systems help service providers to determine the severity of the injury and mortality risk and provide appropriate and timely services. This study aimed to predict mortality risk in patients with traffic injuries in Tabriz hospitals. Materials and Methods: This descriptive cross-sectional study included 11,238 traffic-injured patients. Databases of the emergency medicine service and forensic medicine were used to collect information. Glasgow Coma Scale, Age, and Systolic Blood Pressure (GAP) scoring system, binary logistic regression model, odds ratio with 95% confidence interval, and sensitivity and specificity were used to predict mortality. Results: Overall, 71 cases of death were identified. Pedestrians had the most rates of deaths with 31 cases (43.66%). Head trauma with 31 cases (43.66%) was the main cause of death. Mean (standard deviation) of the GAP score was 21.8 (1.8). The death rates in high-, moderate-, and low-risk groups were 22.4%, 3.18%, and 0.42%, respectively. The likelihood of death in people with saturation of oxygen (SO2) ≤95 was 1.96 times higher than those with SO2>95. The likelihood of death increased by 0.001 times each year. Furthermore, when the GAP score was ≤18, sensitivity was 64%, and for the GAP score of ≤10, sensitivity was 15.5%. Conclusion: GAP score seems to be a reliable and easy-to-use scoring method for predicting traffic injury mortality in an Iranian setting and yields reasonable results concerning international standards.


1. Baker SP, O’Neill B, O’Neill M, Li G. The Injury Fact Book. 2nd ed. New York: Oxford University Press; 1992. 
2. Moini M, Rezaishiraz H, Zarineh A, Rasouli MR. Evaluation of quality of trauma care in a local hospital using a customization of ASCOT. Eur J Trauma Emerg Surg 2009;35:56‑60. 
3. Zafarghandi MR, Modaghegh MH, Roudsari BS. Preventable trauma death in Tehran: An estimate of trauma care quality in teaching hospitals. J Trauma 2003;55:459‑65. 
4. Latifi R, Ziemba M, Leppäniemi A, Dasho E, Dogjani A, Shatri Z, et al. Trauma system evaluation in developing countries: Applicability of American College of Surgeons/Committee on Trauma (ACS/COT) basic criteria. World J Surg 2014;38:1898‑904. 
5. Stelfox HT, Bobranska‑Artiuch B, Nathens A, Straus SE. Quality indicators for evaluating trauma care: A scoping review. Arch Surg 2010;145:286‑95. 
6. Glen J, Constanti M, Brohi K; Guideline Development Group. Assessment and initial management of major trauma: Summary of NICE guidance. BMJ 2016;353:i3051. 
7. Moore L, Lavoie A, Sirois MJ, Amini R, Belcaïd A, Sampalis JS. Evaluating trauma center process performance in an integrated trauma system with registry data. J Emerg Trauma Shock 2013;6:95‑105. 
8. EsmaeiliED, Sadeghi‑Bazargani H, Vahdati SS, Shokouhi G, SafaiyanA, Lak SS. Assessment of survival and hospital care quality in patients with traffic injury in East Azerbaijan. Trauma Mon 2017;2;e35303. 
9. Ziyab AH, Akhtar S. Incidence and trend of road traffic injuries and related deaths in Kuwait: 2000‑2009. Injury 2012;43:2018‑22. 
10. Sánchez González MP, Escribano Sotos F, Tejada Ponce Á. Impact of provincial characteristics on the number of traffic accident victims on interurban roads in Spain. Accid Anal Prev 2018;118:178‑89. 
11. Nantulya VM, Reich MR. The neglected epidemic: Road traffic injuries in developing countries. BMJ 2002;324:1139‑41. 
12. Rasouli MR, Nouri M, Zarei MR, Saadat S, Rahimi‑Movaghar V. Comparison of road traffic fatalities and injuries in Iran with other countries. Chin J Traumatol 2008;11:131‑4. 
13. Moafian G, Aghabeigi MR, Heydari ST, Hoseinzadeh A, Lankarani KB, Sarikhani Y, et al. An epidemiologic survey of road traffic accidents in Iran: Analysis of driver‑related factors. Chin J Traumatol 2013;16:140‑4. 
14. Peden M, Scurfield R, Sleet D, Mohan D, Hyder AA, Jarawan E, et al. World Report on Road Traffic Injury Prevention. Geneva: World Health Organization; 2004. 
15. 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 2010;69:595‑9. 
16. MacKenzie EJ, Rivara FP, Jurkovich GJ, Nathens AB, Frey KP, Egleston BL, et al. A national evaluation of the effect of trauma‑center care on mortality. N Engl J Med 2006;354:366‑78. 
17. Darbandsar Mazandarani P, Heydari K, Hatamabadi H, Kashani P, Jamali DaneshY. Acute physiology and chronic health evaluation(APACHE) III score compared to trauma‑injury severity score (TRISS) in predicting mortality of trauma patients. Emerg (Tehran) 2016;4:88‑91. 
18. Chawda MN, Hildebrand F, Pape HC, Giannoudis PV. Predicting outcome after multiple trauma: Which scoring system? Injury 2004;35:347‑58. 
19. Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME. A revision of the trauma score. J Trauma 1989;29:623‑9. 
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:R191. 
21. Ahun E, Köksal Ö, Sığırlı D, Torun G, Dönmez SS, Armağan E.Value of the glasgow coma scale, age, and arterial blood pressure score for predicting the mortality of major trauma patients presenting to the emergency department. Ulus Travma Acil Cerrahi Derg 2014;20:241‑7. 
22. Yazdani Charati J, Abbasi A, Fenderski A, Ali Pour N. Epidemiology of fatal traffic accidents in Sari, Iran in 2014. J Health Res Commumity 2016;2:61‑8. 23. Ghafari Fam S, Sadeghi Bazargani H, Salarilak S. A survey on epidemiological and demographic aspects of pedestrian road accident victims in Shohada referral university hospital, East Azerbaijan province. J Urmia Uni Med Sci 2014;25:549‑60. 
24. Soltani G, Ahmadi B, Pourreza A, Rahimi A. Investigating prevalence of deaths from traffic accidents and factors associated with it in Yazd in 2009. J Shahid Sadoughi Univ Med Sci 2014;21:831‑9. 
25. Taghipour H, Panahi F, Khoshmohabat H, Firoozabadi NH, Moharamzad Y, Abbasi A. Causes and severity of fatal injuries in autopsies of victims of fatal traffic accidents. J Shahid Sadoughi Univ Med Sci 2010;17:358‑64. 
26. Rahmani F, Bakhtavar HE, Vahdati SS, Hosseini M, Esfanjani RM. Evaluation of MGAP and GAP trauma scores to predict prognosis of multiple‑trauma patients. Trauma Mon 2017;22:e33249. 
27. Perel P, Prieto‑Merino D, Shakur H, Clayton T, Lecky F, Bouamra O, et al. Predicting early death in patients with traumatic bleeding: Development and validation of prognostic model. BMJ 2012;345:e5166. 
28. Sadeghian F, Khosravi A, Emamian MH, Yonesian R. The pattern of road traffic injuries and related factors in Shahrood, Iran. Payesh 2008;7:225‑33.