Comparison of Injury Severity Score, Glasgow Coma Scale, and Revised Trauma Score in Predicting the Mortality and Prolonged ICU Stay of Traumatic Young Children: A Cross-Sectional Retrospective Study

Abstract

Introduction The purpose of this study was to examine the capacity of commonly used trauma scoring systems such as the Glasgow Coma Scale (GCS), Injury Severity Score (ISS), and Revised Trauma Score (RTS) to predict outcomes in young children with traumatic injuries. Methods This retrospective study was conducted for the period from 2009 to 2016 in Kaohsiung Chang Gung Memorial Medical Hospital, a level I trauma center. We included all children under the age of 6 years admitted to the hospital via the emergency department with any traumatic injury and compared the trauma scores of GCS, ISS, and RTS on patients' outcome. The primary outcomes were mortality and prolonged Intensive Care Unit (ICU) stay, with the latter defined as an ICU stay longer than 14 days. The secondary outcome was the hospital length of stay (HLOS). Receiver operating characteristic (ROC) analysis was also adopted with the value of the area under the ROC curve (AUC) for comparing trauma score prediction with patient mortality. Cutoff values from each trauma score for mortality prediction were also measured by determining the point along the ROC curve where Youden's index was maximum. Results We included a total of 938 patients in this study, with a mean age of 3.1 ± 1.82 years. The mortality rate was 0.9%, and 93 (9.9%) patients had a prolonged ICU stay. An elevated ISS (34 ± 19.9 vs. 5 ± 5.1, p=0.004), lower GCS (8 ± 5.0 vs. 15 ± 1.3, p=0.006), and lower RTS (5.58 ± 1.498 vs. 7.64 ± 0.640, p=0.006) were all associated with mortality. All three scores were considered to be independent risk factors of mortality and prolonged ICU stay and had a linear correlation with increased HLOS. With regard to predicting mortality, ISS has the highest AUC value (ISS: 0.975; GCS: 0.864; and RTS: 0.899). The prediction cutoff values of ISS, GCS, and RTS on mortality were 15, 11, and 7, respectively. Conclusion Regarding traumatic injuries in young children, worse ISS, GCS, and RTS were all associated with increased mortality, prolonged ICU stay, and longer hospital LOS. Of these scoring systems, ISS was the best at predicting mortality.

The severity of fall injuries in Saudi Arabia: a cross-sectional study

“…Recently, Huang et al . [ 17 ] conducted a retrospective study including 938 patients in order to determine the capacity of GCS, ISS and revised trauma score (RTS) in young children with trauma. They reported increased mortality, longer hospital and prolonged intensive care unit (ICU) stay with worse ISS, GCS and RTS.…”

Association between prehospital time and outcome of trauma patients in 4 Asian countries: A cross-national, multicenter cohort study

“…RTS, a physiological triage score, was calculated using recoded Glasgow Coma Scale (GCS), systolic blood pressure (SBP), and respiratory rate (RR) using the following formula: RTS = (GCS score coded × 0.9368) + (SBP coded × 0.7326) + (RR coded × 0.2908) [22]. We further dichotomized ISS as <16 or �16 and RTS as <7 or �7; these cutoff values were used in previous studies as cutoff values for major trauma [23][24][25]. The prehospital time intervals were extracted using prehospital timing with maximal valid value (Table B in S1 Text).…”

“…All hospitals from these countries participating in the investigation are academic teaching hospitals with functional capability for trauma resuscitation. The median (Q1-Q3) of RT, SH, and TPT were 20 (Q1-Q3: 12-39), 21 (Q1-Q3: [16][17][18][19][20][21][22][23][24][25][26][27][28][29], and 47 (Q1-Q3: 32-60) minutes. Mortality within 30 days after injury occurred in 280 patients (1.1%).…”

Comparison of Shiraz Trauma Transfusion Score (STTS) Potency With Common Scoring Systems for Trauma in Predicting the Short and Long Term Mortality of Injured Patients

“…[7] Since then, many other scoring systems such as Injury Severity System (ISS), Trauma Injury Severity score (TISS), A Severity Characterization of Trauma (ASCOT), New Injury Severity Score (NISS), and the Harborview Assessment of Risk of Mortality (HARM) have been introduced. Recently, MGAP (Mechanism, Glasgow Coma Scale, Age, and Systolic Blood Pressure) and Revised Trauma Score (RTS) which includes Glasgow Coma Scale (GCS), systolic blood pressure and respiratory rate were introduced and shortly became the most commonly used methods in emergency departments [8,9].…”