Glasgow Coma Scale Versus Physiologic Scoring Systems in Predicting the Outcome of ICU admitted Trauma Patients; a Diagnostic Accuracy Study

There is no consensus on the performance of decision rules in predicting the prognosis of traumapatients. Therefore, the present study aimed to compare the value of Glasgow coma scale (GCS) and physiologicscoring systems in predicting mortality and poor outcome of trauma patients.

This diagnostic accu-racy study was conducted on multiple trauma patients admitted to the intensive care units of two hospitals inTehran, Iran, from 21 November 2020 to 22 May 2021. The patients’ demographic characteristics, length of stayin the intensive care unit (ICU), the vital signs, and the GCS on admission were recorded. Finally, the mortal-ity, disability, and complete recovery of patients at the time of discharge were evaluated and receiver operatingcharacteristics (ROC) curve analysis was used to compare the performance of physiologic scoring systems withGCS.

200 trauma patients with the mean age of 43.53±19.84 years were evaluated (74% male). The areaunder the ROC curve for New Trauma Score (NTS), Revised Trauma Score (RTS), Worthing Physiological Scor-ing System (WPSS), Rapid Acute Physiology Score (RAPS), Rapid Emergency Medicine Score (REMS), ModifiedEarly Warning Score (MEWS), National Early Warning Score (NEWS), Glasgow Coma Scale, Age, and SystolicBlood Pressure score (GAPS) ,Glasgow coma scale (GCS) in prediction of mortality were 0.95, 0.95, 0.83, 0.89,0.91, 0.84, 0.77, 0.97, and 0.98 respectively. The performance of GCS was statistically superior to RTS (P=0.005),WPSS (P=0.0001), RAPS (P=0.0002), REMS (P=0.002), MEWS (P<0.0001), and NEWS (P<0.0001). However, theperformance of GCS, NTS (P=0.146), and GAPS (P=0.513) were not significantly different. Also, in predictionof poor outcomes, the AUC of GCS (0.98) was significantly higher than RTS (0.95), RAPS (0.85), REMS (0.85),MEWS (0.84), NEWS (0.77), and WPSS (0.75).

The GCS score seems to be a better instrument topredict mortality and poor outcome in trauma patients compared to other tools due to its high accuracy, wideapplication, and easy calculation.