Comparison of Trauma Scoring Systems for Mortality Prediction in Adult Blunt Trauma Patients: A Prospective Observational Study

Abstract

: Background: Trauma severity scores are used to estimate mortality risk, but performance varies across settings. We compared trauma scoring systems and evaluated the Glasgow Coma Scale as a predictor of mortality. Methods: This prospective study included 113 adults with blunt trauma admitted to a tertiary centre. Injury Severity Score, New Injury Severity Score, Revised Trauma Score, Trauma and Injury Severity Score, and Glasgow Coma Scale were assessed. Discrimination was evaluated using area under the receiver operating characteristic curve. Pairwise comparisons used DeLong testing. Calibration was assessed using the calibration intercept, calibration slope, and Brier score, while clinical utility was evaluated using decision curve analysis. Results: Thirty-nine patients died. All measures demonstrated discrimination. The Revised Trauma Score had the highest area under the curve (0.948), followed by the Glasgow Coma Scale (0.945), Injury Severity Score and New Injury Severity Score (0.934 each), and Trauma and Injury Severity Score (0.913). However, pairwise comparisons showed no differences between the trauma scoring systems. The Revised Trauma Score showed favourable calibration. Conclusion: All scores provided mortality discrimination. The advantage of the Revised Trauma Score was not statistically definitive, supporting multicentre validation studies.