Scoring severity in trauma: comparison of prehospital scoring systems in trauma ICU patients

  • J. A. Llompart-PouEmail author
  • M. Chico-Fernández
  • M. Sánchez-Casado
  • R. Salaberria-Udabe
  • C. Carbayo-Górriz
  • F. Guerrero-López
  • J. González-Robledo
  • M. Á. Ballesteros-Sanz
  • R. Herrán-Monge
  • L. Servià-Goixart
  • R. León-López
  • E. Val-Jordán
Original Article



We evaluated the predictive ability of mechanism, Glasgow coma scale, age and arterial pressure (MGAP), Glasgow coma scale, age and systolic blood pressure (GAP), and triage-revised trauma Score (T-RTS) scores in patients from the Spanish trauma ICU registry using the trauma and injury severity score (TRISS) as a reference standard.


Patients admitted for traumatic disease in the participating ICU were included. Quantitative data were reported as median [interquartile range (IQR), categorical data as number (percentage)]. Comparisons between groups with quantitative variables and categorical variables were performed using Student’s T Test and Chi Square Test, respectively. We performed receiving operating curves (ROC) and evaluated the area under the curve (AUC) with its 95 % confidence interval (CI). Sensitivity, specificity, positive predictive and negative predictive values and accuracy were evaluated in all the scores. A value of p < 0.05 was considered significant.


The final sample included 1361 trauma ICU patients. Median age was 45 (30–61) years. 1092 patients (80.3 %) were male. Median ISS was 18 (13–26) and median T-RTS was 11 (10–12). Median GAP was 20 (15–22) and median MGAP 24 (20–27). Observed mortality was 17.7 % whilst predicted mortality using TRISS was 16.9 %. The AUC in the scores evaluated was: TRISS 0.897 (95 % CI 0.876–0.918), MGAP 0.860 (95 % CI 0.835–0.886), GAP 0.849 (95 % CI 0.823–0.876) and T-RTS 0.796 (95 % CI 0.762–0.830).


Both MGAP and GAP scores performed better than the T-RTS in the prediction of hospital mortality in Spanish trauma ICU patients. Since these are easy-to-perform scores, they should be incorporated in clinical practice as a triaging tool.


Trauma Scales Scoring Mortality prediction 


Compliance with ethical standards

Ethics Committee approval for the registry was obtained. The study was performed according to the Declaration of Helsinki Statement.

Conflict of interest

Juan Antonio Llompart-Pou, Mario Chico-Fernández, Marcelino Sánchez-Casado, Ruth Salaberria-Udabe, Cecilia Carbayo-Górriz, Francisco Guerrero-López, Javier González-Robledo, María Ángeles Ballesteros-Sanz, Rubén Herrán-Monge, Lluís Servià-Goixart, Rafael León-López and Estela Val-Jordán declare that they have no conflict of interest.


RETRAUCI received funding from the Fundación Mutua Madrileña during 3 years for the development of a web-based database Granted to the principal investigator (Dr. Chico-Fernández, AP117892013), on behalf of the GT Trauma y Neurointensivismo SEMICYUC.


  1. 1.
    Haagsma JA, Graetz N, Bolliger I, Naghavi M, Higashi H, Mullany EC, et al. The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease study 2013. Inj Prev. 2016;22:3–18.CrossRefPubMedGoogle Scholar
  2. 2.
    Alberdi F, García I, Atutxa L, Zabarte M. Trauma and Neurointensive Care Work Group of the SEMICYUC. Epidemiology of severe trauma. Med Intensiva. 2014;38:580–8.CrossRefPubMedGoogle Scholar
  3. 3.
    MacKenzie EJ, Rivara FP, Jurkovich GJ, Nathens AB, Frey KP, Egleston BL, et al. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med. 2006;354:366–78.CrossRefPubMedGoogle Scholar
  4. 4.
    Cameron PA, Gabbe BJ, Smith K, Mitra B. Triaging the right patient to the right place in the shortest time. Br J Anaesth. 2014;113:226–33.CrossRefPubMedGoogle Scholar
  5. 5.
    Lefering R. Trauma scoring systems. Curr Opin Crit Care. 2012;18:637–40.CrossRefPubMedGoogle Scholar
  6. 6.
    Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME. A revision of the trauma score. J Trauma. 1989;29:623–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Boyd CR, Tolson MA, Copes WS. Evaluating trauma care: the TRISS method. Trauma Score and the Injury Severity Score. J Trauma. 1987;27:370–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Chico-Fernández M, Llompart-Pou JA, Sánchez-Casado M, Alberdi-Odriozola F, Guerrero-López F, Mayor-García MD et al. En representación del Grupo de Trabajo de Trauma y Neurointensivismo SEMICYUC. Mortality prediction using the TRISS methodology in the Spanish Trauma ICU registry (RETRAUCI). Med Intensiva. 2016.
  9. 9.
    Sartorius D, Le Manach Y, David JS, Rancurel E, Smail N, Thicoïpé 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;38:831–7.CrossRefPubMedGoogle Scholar
  10. 10.
    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:R191.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Bouzat P, Legrand R, Gillois P, Ageron FX, Brun J, Savary D, et al. TRENAU Group. Prediction of intra-hospital mortality after severe trauma: which pre-hospital score is the most accurate? Injury. 2016;47:14–8.CrossRefPubMedGoogle Scholar
  12. 12.
    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;20:241–7.CrossRefPubMedGoogle Scholar
  13. 13.
    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;77:757–63.CrossRefPubMedGoogle Scholar
  14. 14.
    Martín Quirós A, Borobia Pérez A, Pertejo Fernández A, Pérez Perilla P, Rivera Núñez A, Martínez Virto AM, Quintana Díaz M. [Mortalidad en el traumatismo potencialmente grave atendido en un servicio de urgencias de tercer nivel. Evaluación de la escala pronóstica de mortalidad GAP.] Emergencias 2015; 27:371–4. Spanish.Google Scholar
  15. 15.
    Chico-Fernández M, Llompart-Pou JA, Guerrero-López F, Sánchez-Casado M, García-Sáez I, Mayor-García MD, et al. En representación del Grupo de Trabajo de Trauma y Neurointensivismo SEMICYUC. Epidemiology of severe trauma in Spain. Registry of trauma in the ICU (RETRAUCI). Pilot phase. Med Intensiva. 2015 Oct 1. pii: S0210-5691(15)00171-0. doi:  10.1016/j.medin.2015.07.011.
  16. 16.
    Hollis S, Yates DW, Woodford M, Foster P. Standardized comparison of performance indicators in trauma: a new approach to case-mix variation. J Trauma. 1995;38:763–6.CrossRefPubMedGoogle Scholar
  17. 17.
    O’Reilly GM, Cameron PA, Jolley DJ. Which patients have missing data? An analysis of missingness in a trauma registry. Injury. 2012;43:1917–23.CrossRefPubMedGoogle Scholar
  18. 18.
    Gerdin M, Roy N, Khajanchi M, Kumar V, Dharap S, Felländer-Tsai L, et al. Predicting early mortality in adult trauma patients admitted to three public university hospitals in urban India: a prospective multicentre cohort study. PLoS One. 2014;9:e105606.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Hashmi A, Ibrahim-Zada I, Rhee P, Aziz H, Fain MJ, Friese RS, et al. Predictors of mortality in geriatric trauma patients: a systematic review and meta-analysis. J Trauma Acute Care Surg. 2014;76:894–901.CrossRefPubMedGoogle Scholar
  20. 20.
    Min L, Burruss S, Morley E, Mody L, Hiatt JR, Cryer H, et al. A simple clinical risk nomogram to predict mortality-associated geriatric complications in severely injured geriatric patients. J Trauma Acute Care Surg. 2013;74:1125–32.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Chang DC, Bass RR, Cornwell EE. Mackenzie EJ (2008) Undertriage of elderly trauma patients to state-designated trauma centers. Arch Surg. 2008;143:776–81 (discussion 782).CrossRefPubMedGoogle Scholar
  22. 22.
    Sasser SM, Hunt RC, Faul M, Sugerman D, Pearson WS, Dulski T, et al; Centers for Disease Control and Prevention (CDC). Guidelines for field triage of injured patients: recommendations of the National Expert Panel on Field Triage, 2011. MMWR Recomm Rep. 2012; 61(RR-1):1–20.Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • J. A. Llompart-Pou
    • 1
    Email author
  • M. Chico-Fernández
    • 2
  • M. Sánchez-Casado
    • 3
  • R. Salaberria-Udabe
    • 4
  • C. Carbayo-Górriz
    • 5
  • F. Guerrero-López
    • 6
  • J. González-Robledo
    • 7
  • M. Á. Ballesteros-Sanz
    • 8
  • R. Herrán-Monge
    • 9
  • L. Servià-Goixart
    • 10
  • R. León-López
    • 11
  • E. Val-Jordán
    • 12
  1. 1.Servei de Medicina IntensivaHospital Universitari Son EspasesPalma de MallorcaSpain
  2. 2.UCI de Trauma y Emergencias, Servicio de Medicina IntensivaHospital Universitario 12 de OctubreMadridSpain
  3. 3.Servicio de Medicina IntensivaHospital Virgen de la SaludToledoSpain
  4. 4.Servicio de Medicina IntensivaHospital Universitario de DonostiaSan SebastiánSpain
  5. 5.Servicio de Medicina IntensivaComplejo Hospitalario de TorrecárdenasAlmeríaSpain
  6. 6.Servicio de Medicina IntensivaHospital Universitario Virgen de las NievesGranadaSpain
  7. 7.Servicio de Medicina IntensivaComplejo Asistencial Universitario de SalamancaSalamancaSpain
  8. 8.Servicio de Medicina IntensivaHospital Universitario Marqués de ValdecillaSantanderSpain
  9. 9.Servicio de Medicina IntensivaHospital Universitario Río HortegaValladolidSpain
  10. 10.Servicio de Medicina IntensivaHospital Universitari Arnau de VilanovaLleidaSpain
  11. 11.Servicio de Medicina IntensivaCiudad Sanitaria Reina SofiaCórdobaSpain
  12. 12.Servicio de Medicina IntensivaHospital Universitario Miguel ServetZaragozaSpain

Personalised recommendations