Physiologic Scoring Systems versus Glasgow Coma Scale inPredicting In-Hospital Mortality of Trauma Patients; a Di-agnostic Accuracy Study

In recent years, several scoring systems have been developed to assess the severity of traumaand predict the outcome of trauma patients. This study aimed to compare Rapid Emergency Medicine Score(REMS), Modified Early Warning Score (MEWS), Injury Severity Score (ISS), and Glasgow Coma Scale (GCS) inpredicting the in-hospital mortality of trauma patients.

This diagnostic accuracy study was done onadult patients admitted to the emergency department (ED) between June 21, 2019, and September 21, 2020,following multiple trauma. Patients were followed as long as they were hospitalized. The REMS, MEWS, GCS,and ISS were calculated after data gathering and comprehensive assessment of injuries. Receiver operatingcharacteristics (ROC) analysis was performed to examine the prognostic performance of the four different tools.

Of the 754 patients, 32 patients (4.2%) died and 722 (95.8%) survived after 24 hours of admission. Themean age of the patients was 38.54 ± 18.58 years (78.9% male). The area under the ROC curves (AUC) of REMS,MEWS, ISS, and GCS score for predicting in-hospital mortality were 0.942 (95% CI [0.923-0.958]), 0.886 (95% CI[0.861-0.908]), 0.866 (95% CI [0.839-0.889]), and 0.851 (95% CI [0.823-0.876]), respectively. The AUC of REMSwas significantly higher than GCS (p=0.035). The sensitivities of GCS≤11, ISS≥13, REMS≥4, and MEWS≥3 scores for in-hospital mortality were 0.56, 0.97, 0.81, and 0.94, respectively. Also, the specificities of GCS, ISS,REMS, and MEWS scores for in-hospital mortality were 0.93, 0.82, 0.81, and 0.85, respectively.

Itseems that REMS is more accurate than GCS, ISS, and MEWS in predicting in-hospital mortality≥24 hours ofmultiple trauma patients.