Evaluati̇on of mortali̇ty and prognosi̇s wi̇th scori̇ng systems i̇n trauma pati̇ents hospi̇tali̇zed from the emergency department to the i̇ntensi̇ve care uni̇t

Objective: The primary aim of this study was to investigate whether there is a correlation between current scoring systems and mortality and prognosis in trauma cases hospitalized from the emergency department to the intensive care unit. The secondary aim of the study was to combine these scoring systems with some blood parameters to build an easy-to-use and more robust model in terms of mortality prediction. Materials and Methods: This study was conducted retrospectively between 01.06.2018 and 31.12.2020 in the Emergency Department of the Faculty Hospital of Yozgat Bozok University. It included 357 trauma patients transferred to the intensive care unit for follow-up and treatment following the emergency department admission. However, 234 patients from these patients, whose full data were accessed and all scores that were the subject of our study could be calculated, were included in the study. The obtained demographic, clinical, physiological, and anatomical data were used for the score calculations. The relationships with the scoring systems (including combinations with blood parameters) and 30-day mortality were analyzed. Results: A total of 234 patients were evaluated in the study. Of these patients, 59.4% were men, and 40.6% were women. The mortality rate was detected as 17.9%. When the scoring systems were examined according to their ability to distinguish between the deceased and the living patient, it was determined that SI and RSI scores were not statistically significant (p>0.05). In contrast, other evaluated scores were statistically significant (p<0.05). ROC analysis showed that SAPS II and APACHE II were the most successful scoring systems in predicting mortality [CI:%95, AUC:0.920 (0.879-0.960) and CI:%95, AUC:0.906 (0.854-0.958), respectively]. In addition, the mortality prediction performances of combined versions of KTS, qSOFA, and CRAMS with lactate were more successful than the original versions [CI: 95%, AUC:0.872 (81.7-92.6, p<0.001); CI:95%, AUC:0.763 (69.2-83.5, p<0.001) and CI:95%, AUC:0.834 (76.2-90.6, p<0.001), respectively)]. Conclusion: The performance of widely used many trauma scoring systems and their combined versions (CRAMS-L, CRAMS-A, KTS-L, KTS-A, qSOFA-L, qSOFA-A), including albumin and lactate, in predicting mortality were evaluated in the study. The scores combined with some blood parameters (especially lactate) outperformed the original versions. The combination of current scoring systems with laboratory parameters may be a promising alternative for prognostic evaluation, especially the mortality prediction, of trauma patients during their follow-up. Keywords: emergency department, mortality, scoring systems, trauma