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 Aug 10;15(4):R191

Authors: Kondo Y, Abe T, Kohshi K, Tokuda Y, Cook EF, Kukita I

ABSTRACT: INTRODUCTION: Our aim was to assess among trauma patients whether the new GAP scoring system, which modified the MGAP (mechanism, Glasgow Coma Scale (GCS), age, and arterial pressure) scoring system, better predicts in-hospital mortality and can be more easily applied in the Emergency Department (ED) than previous trauma scores. METHODS: This multicenter, prospective, observational study was conducted to analyze readily available variables in the ED, which are associated with mortality in trauma patients. The data used in this study were from the Japan Trauma Data Bank (JTDB), which consists of 114 major emergency hospitals in Japan. 35,732 patients with trauma and who were 15 years or older were eligible from 2004-2009. Of this, 27,154 (76%) patients with complete data sets of important data (age, GCS, systolic blood pressure (SBP), respiratory rate, and injury severity score) were used in the analysis. We calculated weight for the predictors of the GAP using 13,463 trauma patients in a derivation data set using logistic regression. Scores for four existing scoring systems (revised trauma score (RTS), triage-RTS, trauma related injury severity score, and the MGAP) were calibrated using logistic regression models that fit in the derivation set. The GAP was compared to the calibrated scoring systems in 13,691 different patients in a validation data set using c-statistics and reclassification tables with defined three risk groups: low (mortality<5%), intermediate, and high risk (mortality>50%) based on a previous publication. RESULTS: Calculated score for the GAP involved: GCS (from 3-15 points), age< 60 yrs (3 points), and SBP (>120 mmHg: 6 points, 60-120mmHg: 4 points). The c-statistic for the GAP (0.933 for long term mortality, 0.965 for short term mortality) was better than or comparable to these the other trauma scores. Compared to existing instruments, reclassification tables showed that the GAP reclassified all patients except one patient in the correct direction. In most cases, the observed incidence of death in patients who were reclassified matched what would have been predicted by the GAP. CONCLUSIONS: The GAP score can predict in-hospital mortality more accurately than the previous trauma scores.

PMID: 21831280 [PubMed - as supplied by publisher]