Prognostic significance of GCS, RTS, TRISS Ps, and ISS in in-hospital mortality

Introduction: Our institution holds Level II trauma center status in Japan. This study aims to illuminate our clinical outcomes and distinct characteristics, including injury patterns and patient backgrounds.

Material & Methods: Conducted as a single-center, retrospective cohort study, we meticulously reviewed medical records of trauma patients in our emergency department during 2020-21. Variables examined encompassed age, gender, injury type, orthopedic injuries, the Glasgow Coma Scale (GCS), blood pressure, respiratory rate, the Revised Trauma Score (RTS), the Injury Severity Score (ISS), Probability of Survival (TRISS Ps), and serum lactate levels.

Results: This comprehensive inquiry encompassed 471 patients, with an ISS above 3. The ISS averaged 16.3 (range 9-75), with a mean patient age of 57.6. Major causes of polytrauma were vehicular accidents and falls. Unfortunately, 30 cases ended in fatalities upon arrival, and 22 patients died during hospitalization. Notably, 209 cases exhibited severe trauma (ISS score ≥16), with 71% concurrently having orthopedic trauma, requiring surgery in 62% of cases. In-hospital deaths were significantly associated with reduced GCS (9.0, ROC analysis AUC 0.92), RTS (6.9, AUC 0.9), ISS (24, AUC 0.65), and TRISS Ps (0.56, AUC 0.81). In-hospital mortality rates were 9.9% (ISS > 16), 3.9% (ISS > 16, TRISS Ps > 0.5), 5.0% (ISS > 9), and 2.3% (ISS > 9, TRISS Ps > 0.5).

Conclusion: In summary, our thorough investigation has delved into the clinical attributes of a Japanese Level II trauma center. Importantly, our study highlights the predictive power of GCS, RTS, TRISS Ps, and ISS regarding in-hospital mortality.

References:Matsumoto S, et al. Trauma Surg Acute Care Open. 2018;3(1):e000247

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