Document Type : Research articles

Authors

1 Emergency and Trauma Care Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

2 Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

3 Associate Professor, Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

Abstract

Background: It is of prime importance to manage trauma patients in the early hours and use easy trauma severity scoring systems to make decisions and evaluate patient prognosis.Objectives: The present study aimed to design a predictive model of the mortality of multi-trauma patients due to traffic accidents.Methods: This cross-sectional analytical study was performed on 600 patients who suffered from multi-trauma caused by traffic accidents from December 2019 to September 2021. Collected data included age, sex, vital signs, trauma mechanism, involved vehicle in the accident, accident location, and hospital outcome.Results: In this study, 600 multi-trauma cases caused by traffic accidents were evaluated. Among the significant variables included in the regression model, age, Mean Arterial Pressure (MAP), Glasgow Coma Scale (GCS), AVPU (Alert, Verbal response, Pain response, Unresponsive), and vehicle versus fixed objects (in Vehicle 2) in the presence of other variables in the model, significantly predicted patient outcomes. Therefore, with the other variables being constant, one unit increase in the age variable increases the probability of death by 1.04 times, one unit increase in the score of the two variables of MAP and GCS, and also the transfer of trauma mechanism from the fixed object to the vehicle reduces death by 0.92, 0.62, and 0.10 times, respectively. In the AVPU variable, the transition from Alert to Verbal, the transition from Verbal to Pain, and the transition from Pain to Unresponsive increases the probability of death by 32, 104, and 567, respectively.Conclusion: In this study, AVPU, age, MAP, primary GCS, and trauma mechanism due to hitting a vehicle with a fixed object had significantly the highest predictive power of hospital mortality in patients with multiple trauma due to traffic accidents, respectively. It is suggested that further studies be performed to replace the AVPU variable with GCS in the newly designed formulas for calculating the severity of trauma to simplify these scores.

Keywords

  1. Khodadadi N, Hosein Babaei Z, Charmi L, Alinia S, Asli A. Epidmiology of trauma due to driving accidents in Poursina trauma research center in Rasht. Journal of Holistic Nursing And Midwifery. 2011;20(64):22-6.
  2. Wui LW, Shaun GE, Ramalingam G, Wai KM. Epidemiology of trauma in an acute care hospital in Singapore. J Emerg Trauma Shock. 2014;7(3):174-9. doi: 10.4103/0974-2700.136860. [PubMed: 25114427].
  3. Shabanian G, Saadati M, Sadeghi B, Rasti Boroujeni M, Kheiri S. Compared of car accident hospital admission rate before and after Ramadan, 2008 in Shahrekord, Iran. Journal of Shahrekord Uuniversity of Medical Sciences. 2011;12(4):70-5.
  4. Ainy E, Soori H, Ganjali M, Baghfalaki T. Eliciting road traffic injuries cost among Iranian drivers' public vehicles using willingness to pay method. Int J Crit Illn Inj Sci. 2015;5(2):108-13. doi: 10.4103/2229-5151.158412. [PubMed: 26157655].
  5. Kondo Y, Abe T, Kohshi K, Tokuda Y, Cook EF, Kukita I. Revised trauma scoring system to predict in-hospital mortality in the emergency department: Glasgow Coma Scale, Age, and Systolic Blood Pressure score. Crit Care. 2011;15(4):191. doi: 10.1186/cc10348. PMID: 21831280].
  6. Soltani Y, Khaleghdoost Mohamadi T, Adib M, Kazemnejad E, Aghaei I, Ghanbari A. Comparing the Predictive Ability for Mortality Rates by GAP and MGAP Scoring Systems in Multiple-Trauma Patients. Journal of Mazandaran University of Medical Sciences. 2018;27(157):118-32.
  7. Rahmani F, Ebrahimi Bakhtavar H, Shams Vahdati S, Hosseini M, Mehdizadeh Esfanjani R. Evaluation of MGAP and GAP Trauma Scores to Predict Prognosis of Multiple-trauma Patients. Trauma Monthly. 2017;22(3):e33249. doi: 10.5812/TRAUMAMON.33249.
  8. Amini K, Abolghasemi Fakhri S, Salehi H, Ebrahimi Bakhtavar H, Rahmani F. Mortality Prediction in Multiple Trauma Patients Using GAP, RTS and NTS Models. Trauma Monthly. 2021;26(5):252-7. doi: 10.30491/TM.2021.262592.1212.
  9. Nirula R, Maier R, Moore E, Sperry J, Gentilello L. Scoop and run to the trauma center or stay and play at the local hospital: hospital transfer's effect on mortality. J Trauma. 2010;69(3):595-9. doi: 10.1097/TA.0b013e3181ee6e32. [PubMed: 20838131].
  10. Mostafaei H, Balafar M, Paknezhad SP, Saadati M, Milanchian N, Namdar AM, et al. The Predictive Value of mREMS and NTS Scores in the Hospital Outcomes of Elderly Patients With a Traffic Accident. International Journal of Aging. 2023;1(1):e11. doi: 10.34172/ija.2023.e11.
  11. Gomez D, Alali AS, Xiong W, Zarzaur BL, Mann NC, Nathens AB. Definitive care in level 3 trauma centres after severe injury: A comparison of clinical characteristics and outcomes. Injury. 2015;46(9):1790-5. doi: 10.1016/j.injury.2015.05.047. [PubMed: 26071325].
  12. Khajoei R, Abadi M, Dehesh T, Heydarpour N, Shokohian S, Rahmani F. Predictive value of the glasgow coma scale, age, and arterial blood pressure and the new trauma score indicators to determine the hospital mortality of multiple trauma patients. Archives of Trauma Research. 2021;10(2):86-91.
  13. DM R. Mortality Prediction in Trauma Patients using Three Different Physiological Trauma Scoring Systems. Panamerican Journal of Trauma, Critical Care & Emergency Surgery. 2017;6(3):160-8. doi: 10.5005/jp-journals-10030-1187.
  14. Mousazadeh Y, Sadeghi-Bazargani H, Janati A, Pouraghaei M, Rahmani F, sokhanvar M. Designing and conducting initial application of a performance assessment model for in-hospital trauma care. BMC Health Serv Res. 2022;22(1):273. doi: 10.1186/s12913-022-07578-2. [PubMed: 35232439].
  15. Sartorius D, Le Manach Y, David JS, Rancurel E, Smail N, Thicoïpe M, et al. Mechanism, glasgow coma scale, age, and arterial pressure (MGAP): a new simple prehospital triage score to predict mortality in trauma patients. Crit Care Med. 2010;38(3):831-7. doi: 10.1097/CCM.0b013e3181cc4a67. [PubMed: 20068467].
  16. Hasler RM, Mealing N, Rothen HU, Coslovsky M, Lecky F, Jüni P. Validation and reclassification of MGAP and GAP in hospital settings using data from the Trauma Audit and Research Network. J Trauma Acute Care Surg. 2014;77(5):757-763. doi: 10.1097/TA.0000000000000452. [PubMed: 25494429].
  17. Ahun E, Köksal Ö, Sığırlı D, Torun G, Dönmez SS, Armağan E. Value of the Glasgow coma scale, age, and arterial blood pressure score for predicting the mortality of major trauma patients presenting to the emergency department. Ulus Travma Acil Cerrahi Derg. 2014;20(4):241-7. doi: 10.5505/tjtes.2014.76399. [PubMed: 25135017].
  18. Emircan S, Ozgüç H, Akköse Aydın S, Ozdemir F, Köksal O, Bulut M. Factors affecting mortality in patients with thorax trauma. Ulus Travma Acil Cerrahi Derg. 2011;17(4):329-33. [PubMed: 21935831].
  19. Selim MA, Marei AG, Farghaly NF, Farhoud AH. Accuracy of mechanism, glasgow coma scale, age and arterial pressure (MGAP) score in predicting mortality in Polytrauma patients. Biolife. 2015;3(2):489-95. doi: 10.5281/zenodo.7269785.
  20. Galvagno SM, Jr, Massey M, Bouzat P, Vesselinov R, Levy MJ, Millin MG, et al. Correlation Between the Revised Trauma Score and Injury Severity Score: Implications for Prehospital Trauma Triage. Prehosp Emerg Care. 2019;23(2):263-270. doi: 10.1080/10903127.2018.1489019. [PubMed: 30118369].