Comparison of Glasgow Coma Scale with Physiologic Scoring Scales in Prediction of In-Hospital Outcome of Trauma Patients; a Diagnostic Accuracy Study

  • Mahmoud Yousefifard ORCID Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran
  • Kavous Shahsavarinia ORCID Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
  • Gholamreza Faridaalee ORCID Department of Emergency Medicine, Maragheh University of Medical Sciences, Maragheh, Iran
  • Hossein Dinpanah ORCID Department of Emergency Medicine, 9-Day Hospital, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
  • Sajjad Ahmadi ORCID Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iran
  • Saeed Safari ORCID Mail Department of Emergency Medicine, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Keywords:
Decision Support Techniques, Glasgow Coma Scale, Multiple Trauma, Patient Outcome Assessment

Abstract

Introduction: Limitations of Glasgow coma scale (GCS) led the researchers to designing new physiologic scoring systems such as revised trauma score (RTS), rapid acute physiology score (RAPS) and rapid emergency medicine score (REMS), and worthing physiological scoring system (WPSS). However, it is not yet known whether these models have any advantage over GCS. Objective: The present study attempted to compare the values of 4 physiologic scoring systems including RTS, RAPS, REMS and WPSS with GCS in predicting in-hospital mortality of trauma patients. Methods: The present diagnostic accuracy study was performed on trauma patients presenting to emergency departments of 4 hospitals in Iran throughout 2017. Patients were clinically evaluated and were followed until discharge from hospital. Finally, the status of patients regarding mortality and poor outcome (death, vegetative status, severe disability, and moderate disability) was recorded and predictive value of GCS was compared with physiologic scales. Results: Area under the ROC curve of GCS in prediction of in-hospital mortality was not significantly different from that of REMS (0.89 vs. 0.91; p=0.298), RAPS (0.89 vs. 0.88; p=0.657), and WPSS (0.89 vs 0.91; p=0.168) but was significantly more than RTS (0.89 vs. 0.85; p=0.002). In addition, area under the ROC curves of GCS, REMS, RAPS, WPSS and RTS in prediction of poor outcome were 0.89, 0.88, 0.88, 0.91, and 0.81, respectively. Area under the ROC curve of GCS in prediction of poor outcome did not differ from area under the ROC curves of REMS (0.89 vs. 0.88; p=0.887), RAPS (0.89 vs. 0.88; p=0.601) and WPSS (0.89 vs. 0.91; p=0.113) but was significantly higher than RTS (0.89 vs. 0.81; p<0.0001). Conclusions: Findings of the present study indicated that GCS is still the best method for evaluating injury severity and trauma patients’ outcome in the emergency department; because it is easier to calculate and assess than many physiologic scales and it has a better performance in predicting in-hospital mortality and poor outcome compared to RTS.

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Published
2020-04-14
How to Cite
1.
Yousefifard M, Shahsavarinia K, Faridaalee G, Dinpanah H, Ahmadi S, Safari S. Comparison of Glasgow Coma Scale with Physiologic Scoring Scales in Prediction of In-Hospital Outcome of Trauma Patients; a Diagnostic Accuracy Study. Adv J Emerg Med. 4(4):e89.
Section
Original article