Prognostic value of scoring tools in severe trauma patients admitted to the emergency department.

BACKGROUND: Severe Trauma is a misleading cause of death in young people. Early assessment of prognosis is the cornerstone in the management of such patients. Several prognostic scores have been proposed during the last decade.

AIM: To evaluate the prognostic performance of trauma scores in terms of mortality in severe trauma patients admitted to the emergency department.

METHODS: This was a prospective, observational and prognostic study with inclusion of severe trauma patients admitted to the emergency department over a 20 months period. We focused on the predictive value of 4 trauma scores in terms of mortality in severe trauma admitted to the resuscitation room. Four scores were included: ISS, NISS, EMTRAS and GAP score. Univariate and multivariate analysis of mortality at the 30th post-traumatic day were conducted with comparison of ROC curves of the scores. Moreover, Correlation between the several scores was studied.

RESULTS: We included 298 patients. The median age was 40 (15-90) years. The sex ratio was 4,5. Clinical characteristics were n (%): GCS ≤ 8: 62 (21); PAS <90 mm Hg: 32 (11) and pulse oximetry <90%: 44 (15). The median ISS was 17 (1-75) and 176 (59%) trauma patients had a score ISS ≥ 16. The median NISS was 22 (1-75). The median EMTRAS was 3 (0-9). The median GAP was 21 (3-26). The global mortality was 21.5%. Independent predictors of mortality were: EMTRAS score ≥ 3 (adjusted OR 1.80, 95% CI [1.05-3.08], p = 0.0033), ISS ≥ 16 (adjusted OR 2.05; 95% CI [1.26-3.46], p = 0.002), GAP <20 (adjusted OR 1.92, 95% CI [1.268-2.92], p = 0.002) 1.74, 95% CI [1.17-2.592], p = 0.005). The GAP score had the best AUC= 0.811 followed by the EMTRAS with an AUC of 0.789. Finally, all the scores were strongly correlated.

CONCLUSION: Severe trauma is a dynamic process with a heavy morbidity and mortality. In our study, physiological scores and combined score were correlated with prognosis as well as anatomical scores and could be proposed for early gravity assessment in severe trauma enhancing triage, management and prognosis of polytrauma patients.