Kaya Murtaza, Yildirim Harun, Toprak Mehmet, Ulu Mehmed
Department of Emergency Medicine, Medical Faculty, Kutahya Health Sciences University, 43020 Kutahya, Turkey.
Emergency Department, Kutahya City Hospital, 43020 Kutahya, Turkey.
Diagnostics (Basel). 2025 Jun 19;15(12):1563. doi: 10.3390/diagnostics15121563.
Trauma scoring systems are essential tools for predicting clinical outcomes in patients with multiple injuries. This study aimed to compare the performance of various anatomical and physiological scoring systems in predicting mortality among patients admitted to the emergency department following traffic accidents. In this prospective observational study, trauma patients presenting with traffic-related injuries were evaluated using seven scoring systems: ISS, NISS, AIS, GCS, RTS, TRISS, and APACHE II. Demographic data, clinical findings, and laboratory values were recorded. The prognostic performance of each score was assessed using ROC curve analysis, and diagnostic metrics including sensitivity, specificity, and likelihood ratios were calculated. Among 554 patients included in the study, the overall mortality rate was 2%. The TRISS and GCS scores demonstrated the highest predictive performance, each with an AUC of 0.98, sensitivity of 100%, and specificity exceeding 93%. APACHE II followed closely with an AUC of 0.97, also achieving 100% sensitivity. NISS (AUC = 0.92) and ISS (AUC = 0.91) were effective anatomical scores, while RTS showed moderate predictive value (AUC = 0.90). Strong correlations were noted between ISS, NISS, and AIS (Rho > 0.85), while RTS was negatively correlated with these anatomical scores. All scoring systems showed statistically significant associations with mortality. TRISS, GCS, and APACHE II were the most effective trauma scoring systems in predicting mortality among emergency department patients. While complex models offer higher accuracy, simpler scores such as RTS and GCS remain valuable for rapid triage. The integration of both anatomical and physiological parameters may enhance early risk stratification and support timely decision-making in trauma care.
创伤评分系统是预测多发伤患者临床结局的重要工具。本研究旨在比较各种解剖学和生理学评分系统在预测交通事故后入住急诊科患者死亡率方面的表现。在这项前瞻性观察研究中，对因交通相关损伤就诊的创伤患者使用七种评分系统进行评估：损伤严重度评分（ISS）、新损伤严重度评分（NISS）、简明损伤定级（AIS）、格拉斯哥昏迷量表（GCS）、修订创伤评分（RTS）、创伤和损伤严重度评分（TRISS）以及急性生理与慢性健康状况评分系统II（APACHE II）。记录人口统计学数据、临床发现和实验室值。使用ROC曲线分析评估每个评分的预后表现，并计算包括敏感性、特异性和似然比在内的诊断指标。在纳入研究的554例患者中，总体死亡率为2%。TRISS和GCS评分表现出最高的预测性能，二者的曲线下面积（AUC）均为0.98，敏感性为100%，特异性超过93%。APACHE II紧随其后，AUC为0.97，敏感性也达到100%。NISS（AUC = 0.92）和ISS（AUC = 0.91）是有效的解剖学评分，而RTS显示出中等预测价值（AUC = 0.90）。注意到ISS、NISS和AIS之间存在强相关性（Rho > 0.85），而RTS与这些解剖学评分呈负相关。所有评分系统均显示与死亡率存在统计学显著关联。TRISS、GCS和APACHE II是预测急诊科患者死亡率最有效的创伤评分系统。虽然复杂模型提供更高的准确性，但诸如RTS和GCS等更简单的评分对于快速分诊仍然很有价值。解剖学和生理学参数的整合可能会加强早期风险分层，并支持创伤护理中的及时决策。
