Derivation and validation of an easy-to-compute trauma score that improves prognostication of mortality or the Trauma Rating Index in Age, Glasgow Coma Scale, Respiratory rate and Systolic blood pressure (TRIAGES) score

Abstract

BackgroundMultiple trauma scores have been developed and validated, including the Revised Trauma Score (RTS) and the Mechanism, Glasgow Coma Scale, Age, and Arterial Pressure (MGAP) score. However, these scores are complex to calculate or have low prognostic abilities for trauma mortality. Therefore, we aimed to develop and validate a trauma score that is easier to calculate and more accurate than the RTS and the MGAP score.MethodsThe study was a retrospective prognostic study. Data from patients registered in the Japan Trauma Databank (JTDB) were dichotomized into derivation and validation cohorts. Patients’ data from the Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage-2 (CRASH-2) trial were assigned to another validation cohort. We obtained age and physiological variables at baseline, created ordinal variables from continuous variables, and defined integer weighting coefficients. Score performance to predict all-cause in-hospital death was assessed using the area under the curve in receiver operating characteristics (AUROC) analyses.ResultsBased on the JTDB derivation cohort (n = 99,867 with 12.5% mortality), the novel score ranged from 0 to 14 points, including 0–2 points for age, 0–6 points for the Glasgow Coma Scale, 0–4 points for systolic blood pressure, and 0–2 points for respiratory rate. The AUROC of the novel score was 0.932 for the JTDB validation cohort (n = 76,762 with 10.1% mortality) and 0.814 for the CRASH-2 cohort (n = 19,740 with 14.6% mortality), which was superior to RTS (0.907 and 0.808, respectively) and MGAP score (0.918 and 0.774, respectively) results.ConclusionsWe report an easy-to-use trauma score with better prognostication ability for in-hospital mortality compared to the RTS and MGAP score. Further studies to test clinical applicability of the novel score are warranted.

Predictive value of qSOFA score for death in emergency department resuscitation room among adult trauma patients:a retrospective study

“…Experts and scholars are still innovating to develop other relatively simple scores, such as Mechanism, Glasgow Coma Scale, Age, and Arterial Pressure (MGAP), Glasgow Coma Scale, Age, and Systolic Blood Pressure score (GAP), New Trauma Score (NTS) and Trauma Rating Index in Age, Glasgow Coma Scale, Respiratory rate and Systolic blood pressure score (TRIAGES) [ 6 – 10 ]. However, few studies have demonstrated the validity of these trauma scores in the ED resuscitation room in China.…”

Development and Validation of a Simplified Prehospital Triage Model Using Neural Network to Predict Mortality in Trauma Patients: The Ability to Follow Commands, Age, Pulse Rate, Systolic Blood Pressure and Peripheral Oxygen Saturation (CAPSO) Model

“…Considering the non-linear relationship between the variables and the outcome, the results of the multivariate generalized additive model were used to delineate the range of all predictors. Simple integers were assigned to the intervals according to the coefficients of the logistic regression, referring to the development of TRIAGES (8). Detailed methods for delineating variable intervals and assigning integer values are provided in the Supplementary Material.…”

“…The NTS (New Trauma Score) score used peripheral oxygen saturation (SpO 2 ) instead of respiratory rate in the RTS and improved the prediction of death in trauma patients (7). The Trauma Rating Index in Age, Glasgow Coma Scale, Respiratory rate and Systolic blood pressure (TRIAGES) score used a generalized additive model to delineate the interval of variables and had better performance than the GAP score with the addition of the respiratory rate variable (8). Composed by the mechanism of trauma RTS, Injury Severity Score (ISS) (9) and age, the Trauma and Injury Severity Score (TRISS) was able to predict trauma mortality accurately (10).…”

Development and validation of a risk-adjustment model for mortality and hospital length of stay for trauma patients: a prospective registry-based study in Australia

“…► Lack of simulation studies to formally compare models. Open access from different countries have suggested that outcome prediction may be improved by utilising these physiologic parameters in different ways 15 ; by reassessing how overall or region-specific injury severity is described 8 16 ; or by introducing new variables such as comorbid status, initial laboratory values or the use of cardiopulmonary resuscitation (CPR) prehospital. 8 17 However, the best variables for risk adjustment or the manner in which complex data such as AIS severities should best be used remain unclear, particularly as comparisons of the performance of existing tools have returned equivocal results, and the performance of these models varies in different populations.…”