Comparative Evaluation of the Revised Trauma Score and MGAP Score for Mortality Prediction in Multiple Trauma Patients: Protocol for a Prospective Observational Study

Comparative Evaluation of the Revised Trauma Score and MGAP Score for Mortality Prediction in Multiple Trauma Patients: Protocol for a Prospective Observational Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Study protocol Comparative Evaluation of the Revised Trauma Score and MGAP Score for Mortality Prediction in Multiple Trauma Patients: Protocol for a Prospective Observational Study Bashar A. Abdulhassan, Abdulillh R. Khamess, Hassan. H. Eladl, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6597313/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Trauma holds up a significant global health burden, particularly in countries like Iraq, which are classified as low and middle-income (LMICs), where the situation is worsened by conflicts, road traffic accidents, as well as inadequate resources for healthcare. Despite the widely accepted role of trauma scoring systems like the Revised Trauma Score (RTS) and the Mechanism, Glasgow Coma Scale, Age, and Arterial Pressure (MGAP) Score in high-income countries, very little has been done to explore their predictive accuracy in low-resource settings. This study will address this gap by assessing and contrasting RTS and MGAP in their ability to predict mortality in Iraqi trauma patients. Methods A prospective observational study will be conducted at Al-Kadhimiya Teaching Hospital, Baghdad, from March to November 2025. Consecutive patients aged ≥ 16 years with multiple traumas (injuries ≥ 2 body regions) presenting within six hours of injury will be enrolled. Exclusions include transfers, pre-evaluation deaths, burns, and pregnancy. Data collection comprises two phases: initial assessment of physiological parameters (GCS, systolic blood pressure, respiratory rate) and injury mechanisms in the emergency department, followed by daily follow-ups in surgical wards/ICU until discharge or death. Primary outcomes include in-hospital mortality, while secondary outcomes assess ICU admission and surgical intervention. Predictive accuracy will be evaluated using the area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, and predictive values via IBM SPSS Statistics. Discussion This study fills the critical gap of evaluating RTS and MGAP under resource-constrained conditions in Iraq, where prehospital time delays and poor capacity in the ICU are negative factors that influence trauma outcomes. This will lead to better triage protocols for directing patients toward high-risk categories while utilizing resources effectively in an overcrowded ED. Single-center design and variability in clinical expertise limit this study. Future research should be expanded to multicenter cohorts and long-term outcomes. Refined trauma care strategies will thus reduce avoidable deaths through the contextualization of global evidence relating to the challenges that confront Iraq. Trial Registration: Registered prospectively at ClinicalTrials.gov (ID: NCT06744985) and approved by the Institutional Review Board of Al-Nahrain University College of Medicine (ID: UNCOMIRB20250382). Revised Trauma Score (RTS) MGAP Score mortality prediction multiple trauma patients in-hospital mortality ICU admission low-resource settings Figures Figure 1 Introduction Trauma presents a significant global health threat, being the sixth leading cause of death and the fifth leading cause of moderate to severe disability worldwide, because it causes more than 4.4 million yearly deaths and generates 10% of global disability-adjusted life years (DALYS) [ 1 ]. Road traffic accidents (RTAs) and falls, together with interpersonal violence and conflict-related injuries, serve as the primary mechanisms for fatalities, while RTAs specifically result in 1.3 million annual deaths that primarily influence low- and middle-income nations (LMICs) [2–4]. In low- and middle-income countries, the trauma-related death rates are three times higher than in high-income countries due to inadequate prehospital care, restricted emergency service availability, and limited resources [5]. Trauma-related health problems in Iraq have become worse due to long-running fighting, along with structural issues and limited medical care capabilities. Traumatic injuries cause 22% of all deaths across the nation, while road traffic accidents (RTAs) represent 35% of trauma cases, blast injuries follow with 28%, and interpersonal violence at 15% [6, 7]. Trauma injuries resulting from conflicts often lead to severe cases because patients experience prolonged delays to care and have intricate damage patterns from polytrauma [8]. Prehospital care delays, experienced by over 40% of trauma patients in conflict-affected regions, contribute to significantly worse outcomes, including an 18% pre-hospital mortality rate [9, 10]. These delays are exacerbated by critical resource limitations, such as shortages of imaging tools, blood products, and intensive care facilities, which hinder the implementation of modern trauma treatment protocols, particularly in rural and war-torn areas [9, 11]. The systemic problems in Iraq require immediate development of tailored triage instruments to reflect the specialised trauma statistics and healthcare structure authentic to Iraq's nation. Scoring systems are categorized into anatomical, physiological, or combined types [12, 13]. The AIS, ISS, and NISS are anatomical scoring systems based on different anatomical factors, including the location and severity of injuries [14–16]. In contrast, The GCS, RTS, and PHI are scoring systems based on physiological data collected during physical exams [16]. Additionally, the TRISS, NTRISS, and TRISS are integrated scoring systems that include both anatomical and physiological features of trauma [17–20]. The RTS (Revised Trauma Score) is a physiological scoring system used to assess trauma patients. Initially developed and evaluated through a study involving over 2,000 individuals, the RTS includes three essential physiological indicators: the Glasgow Coma Scale (GCS), Systolic Blood Pressure (SBP), and Respiration Rate (RR) [21, 22]. MGAP is a physiological score that has been developed to predict survival outcomes in individuals experiencing trauma. Although it has been validated in research settings, it remains underutilized in low- and middle-income regions, despite its promise and practicality. MGAP stands for the mechanism of injury (M), Glasgow Coma Scale (G) score, patient age (A), and systolic blood pressure (P). This scoring system was validated in France for its effectiveness in predicting 30-day mortality [23–25]. This study seeks to evaluate the diagnostic accuracy of the Revised Trauma Score (RTS) compared to MGAP in assessing the clinical outcomes of multiple trauma patients admitted to a trauma center. Objectives Primary Objective: This study aims to assess and compare the predictive accuracy of the Revised Trauma Score (RTS) and the MGAP Score in predicting in-hospital mortality for multiple trauma patients admitted to the emergency department. Secondary Objectives: To evaluate and compare the accuracy of the Revised Trauma Score (RTS) and MGAP Score in predicting the need for ICU admission. To assess the predictive accuracy of both scores in identifying patients who require surgical intervention. Methods Study Design This prospective observational study will assess and compare the predictive accuracy of the Revised Trauma Score (RTS) and the MGAP Score for in-hospital mortality, ICU admission, and the need for surgical intervention among multiple trauma patients from March to November 2025. This study represents part of Phase I of the Iraqi Trauma Score Project: A Multi-Phase National Study on Outcomes Prediction. This extensive multi-center nationwide project aims to compare the performance and predictive accuracy of various trauma scoring systems in Iraq. Phase I is currently in progress at the Emergency Department of Al-Kadhimiya Teaching Hospital. It will expand to include Phase II, which will take the study beyond the borders of Baghdad and into four major trauma centers in the capital. Phase III will consist of multiple trauma centers spread across different provinces. The phased design aims for a thorough and regionally representative evaluation of trauma score effectiveness across various clinical settings. Study Setting This study will be conducted at Al-Imamayn Al-Kadhimayn Medical City (mostly referred to as Al-Kadhimiya Teaching Hospital), located at Kadhimiya, a historic district in Baghdad, Iraq. The hospital is one of the country's largest and busiest tertiary care centers. It provides various specialized medical and surgical services, including emergency and trauma care. It serves as a highly rated and significant referral center for northern Baghdad and surrounding areas experiencing significantly increased volumes of trauma cases associated with road traffic accidents, falls, and violence-related injuries. Sample Size The sample will include all cases of multiple traumas that come to the emergency department of Kadhimiya Teaching Hospital during the data-gathering period. There will be no explicit sample size calculation as this is a prospective observational study aimed at including a consecutive sample of eligible patients to reflect real-world emergency department presentations. Study Population Patients aged ≥ 16 years who presented with multiple traumas to the emergency department during the study period will be included as a study population. Multiple trauma is defined as injuries involving two or more body regions or organ systems that might need coordinated multidisciplinary management. Patients will include both males and females, and a variety of kinds of trauma mechanisms will be involved in the study, including road traffic accidents, falls from height, and violence-associated injuries that are familiar sources of trauma in Iraq. Inclusion Criteria 1- Aged 16 years or older. 2- Presented with multiple trauma 3- Complete clinical data will be available at the presentation. 4- Provided informed consent (or consent obtained from a relative or legal representative if the patient is unable to consent due to clinical condition). 5- Capability to assess outcomes such as survival, ICU admission, and complications. 6- Presentation to the trauma center within 6 hours of injury. Exclusion Criteria 1- Transfers from other facilities with interventions that could impact RTS or MGAP reliability. 2- Patients who expired before scoring or evaluation 3- Pregnant patients, due to the unique considerations of trauma in pregnancy. 4- Burn injuries as the primary trauma mechanism. Data Collections All data collection commenced after the study's approval by the Institutional Review Board at the College of Medicine—Al-Nahrain University and study registration on ClinicalTrials.gov. It will be organized into two separate phases: the first phase in the Emergency Department (ED) and the second phase during follow-up in the hospital surgical wards or Intensive Care Unit (ICU), as shown in Fig. 1 During the first phase, trauma patients will be assessed by trained data collectors upon arrival in the ER. Clinical parameters will be recorded as initial assessment parameters regarding vitals, level of consciousness, and sociodemographic variables such as age, sex, height, and weight. Trauma-related factors will also be recorded, including the date and time of trauma, location of injury, type of trauma, mechanism of injury, and mode of transport to the hospital. Previous medical history, initial investigations, laboratory and imaging, and full-body examination findings will be noted. All variables used to calculate the Revised Trauma Score (RTS) and MGAP score will be collected meticulously. The need for timely or urgent surgical or procedural intervention, blood transfusion, ICU admission, and mechanical ventilation, as well as any complications or deaths that occurred in the emergency department, will be noted. In the second phase, the same patients will be followed up during their hospital stay in the ward or ICU until discharge to home or death to monitor clinical progress and outcomes. Daily follow-ups will be done for all patients in the ICU and surgical wards to monitor vital signs, need for surgical intervention, blood transfusion, ICU transfer (if initially admitted to the ward), complications, and the outcome, including being discharged or death. All consequent events will be meticulously recorded, including actual dates and times of ICU admission, surgical procedures, discharge from the hospital, and death. Information will be stored in a secure electronic database system, and anonymized patient codes will protect the confidentiality of their information. Quality control methods include periodic audits and data entry validation during the entire data collection process. For purposes of data validation and consistency, all data collectors underwent a standardized 7-day training program conducted by two professors in the fields of surgery and emergency medicine. Training will be imparted in clinical evaluation methods, ethics, and standard forms for documentation. At every step, the process will be conducted with adherence to IRB-mandated guidelines. To avoid fatigue-related errors, possibly giving rise to bias, the data collectors worked only one day per week throughout the study. Independent Variables The independent variables in this study include an exhaustive list of sociodemographic, clinical, and trauma-related information drawn at the first assessment in the Emergency Room (ER) and a series of subsequent follow-ups in the surgical wards or the ICU. Variables collected in the ER included: Sociodemographic: age of the patient, sex (male or female), height in centimeters, and weight in kilograms. Dates and times of trauma, day of injury, places where the injury happened, and specific injury details will be trauma-specific information recorded at the presentation. Clinical aspects of the trauma will be thoroughly documented: chief complaint (C.C.) and its duration; type of trauma characterized as blunt or penetrating, or both; and mechanism of injury, which could include road traffic accident (RTA), falls from height (FFH), gunshot wounds, motorcycle-related injuries, or knife injuries. Initial vital signs included blood pressure (systolic/diastolic), respiratory rate (RR), pulse rate (PR), temperature, oxygen saturation (O₂%), and glucose level. Capillary refill time will also be assessed as an indicator of peripheral perfusion. The level of consciousness, as measured by Glasgow Coma Scale (GCS) scores, will be additionally documented. These parameters will be vital for calculating the Revised Trauma Score (RTS) and MGAP Score. History in detail, past medical involving the presence of heart failure (HF), chronic kidney disease (CKD), or hypertension (HTN), diabetes mellitus (DM), stroke condition, smoking status, alcohol consumption, cancer, cardiovascular diseases, acute renal failure, chronic liver disease, chronic respiratory disease, and immunosuppression, like HIV/AIDS or long-term steroid use, will be considered for their possible effect on trauma outcomes and mortality. Laboratory investigations on admission included serum sodium (Na), potassium (K), calcium (Ca²⁺), chloride (Cl), urea, serum creatinine, blood urea nitrogen (BUN), hemoglobin (Hb), hematocrit, white blood cell (WBC), platelet count, and liver function evaluated with levels of AST, ALT, total bilirubin, and direct bilirubin. Findings from the physical examination will be additionally documented in a structured form, including systems related to trauma assessment. These findings included abdominal, chest, cardiac, and rapid neurological examinations. Additional trauma-related injury analysis radiologically included X-ray, ultrasound (U/S), and CT scans, with all abnormal or significant findings contained in the patient's profile. Follow-up variables (in the Surgical Wards or ICU) During the whole period of hospitalization in either intensive care (ICU) or surgical wards, all follow-up variables will be carefully recorded for observation of patient status and, especially, for obtaining essential clinical outcomes. Complete daily vital signs will be recorded for BP, RR, PR, and O₂ saturation to note early trends or signs of deteriorating/increasing improvement. Value and outcome recording include the number and category of emergency or urgent surgical procedures done on the patient and whether the patient died in surgery. Date, time, and surgical duration. Blood transfusions during ward stay will also be documented, and how many blood bags will be used. Complications will be extensively assessed during hospitalization, such as chest infection, ileus, deep vein thrombosis (DVT), malnutrition, acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), hypotension or shock, imbalance in electrolytes, cardiac arrhythmias, pressure sores, stroke, anemia, sepsis, and stress ulcers. There will be documentation of complications to assess the burden of morbidity. Furthermore, any subsequent need for admission to the ICU after the initial evaluation will be recorded. Outcomes, either discharge, ICU admission, or death, will be explicitly documented with exact dates and times. These independent variables will be collectively chosen to ensure a complete assessment of each patient's clinical status upon presentation and to facilitate comparative analyses of trauma severity scoring systems. Scoring System Revised Trauma Score (RTS) It is a physiologic scoring system used to assess the severity of trauma based on a patient’s initial vital signs. It combines three parameters: Glasgow Coma Scale (GCS), systolic blood pressure (SBP), and respiratory rate (RR). Table 1 The score ranges from 0 to approximately 7.84, where a lower score indicates more severe trauma and a higher mortality risk [21, 22]. The RTS is calculated using a weighted formula that emphasizes neurological status: RTS = 0.9368×GCSscore + 0.7326×SBPscore + 0.2908×RRscore RTS = 0.9368× GCSscore + 0.7326× SBPscore + 0.2908× RRscore In triage systems, patients with RTS of 12 (sum of raw scores before weighting) may be labeled delayed, 11 urgent, and 3–10 immediate; below 3 is usually considered non-survivable [22, 26]. Table 1 Parameters and Point Values Used in Calculating the Revised Trauma Score Assigned Numeric Value GCS SBP RR 4 13–15 > 89 10–29 3 9–12 76–89 > 29 2 6–8 50–75 6–9 1 4–5 1–49 1–5 0 3 0 0 Mechanism, Glasgow coma scale, Age, and Arterial pressure (MGAP) Score: A trauma scoring system was designed to predict mortality in trauma patients based on four variables: Mechanism of injury, Glasgow Coma Scale (GCS), Age, and arterial Pressure (systolic blood pressure). Table 2 It is simple to calculate and useful for triage and prognosis prediction in trauma care. Total scores can range from 3 to 29, with a higher score predicting a better prognosis [24, 27]. A cutoff score of 22 is often used to distinguish higher risk, and it shows high sensitivity and specificity for mortality prediction [23, 25]. Table 2 MGAP scoring systems and the corresponding points for each variable Variable Assigned Numeric Value Age 60 years 0 GCS Score + 3–15 Mechanism of trauma Blunt trauma + 4 Penetrating trauma 0 SBP > 120 mmHg + 5 60—120 mmHg + 3 < 60 mmHg 0 Outcomes Primary Outcome: In-hospital mortality of multiple trauma patients. This refers to any death occurring during the initial evaluation in the emergency department, in theatre, or throughout the hospital stay in the ICU or surgical wards until discharge. Time Frame: In-Hospital Phase (average of 7 days to discharge) Accuracy Assessment of the Revised Trauma Score (RTS): Total RTS score from 0 to about 12; the lower the score, the higher the injury and risk of mortality. Time Frame: the first 6 hours after ER admission Accuracy Assessment of the MGAP score (mechanism, Glasgow coma scale, Age, and blood pressure). Total scores can range from 3 to 29, with a higher score predicting a better prognosis. Time Frame: the first 6 hours after ER admission Secondary Outcomes: Length of Hospitalization: Length of stay beginning from admission and discharge of each patient; counts in days spent in surgical wards, ICU, and other departments for the treatment course. Time Frame: Up to discharge, an average of 7 days ICU Admission- The presence of marked clinical deterioration, serious complications, or need for advanced monitoring and life-support measures shall determine ICU admission. Time Frame: Up to discharge, an average of 7 days Surgical Intervention: There is a need for surgical intervention during a trauma patient's hospital stay. Time Frame: Up to discharge, an average of 7 days Ethical Approval and Prospective Study Registration The study was approved by the Institutional Review Board (IRB) of the College of Medicine, Al-Nahrain University, under approval ID: UNCOMIRB20250382. It will be conducted according to the ethical principles of the Declaration of Helsinki and local ethical guidelines. Also Registered Prospectively at ClinicalTrials.gov with Registration ID: NCT06744985. Enrolled participants or their legal representatives (if the patient is unable to provide consent) will be verbally informed of the study's purpose, procedures, and confidentiality. Prior to commencing data collection, verbal informed consent will be elicited from every participant within the guidelines provided by the IRB, and this consent will be recorded appropriately in the study records. Artificial Intelligence Disclosure Statement This research study harnessed artificial intelligence tools in various research processes. ChatGPT, for example, was employed to check the manuscript for grammatical and spelling errors to ensure clarity and correctness. Moreover, SciSpace sought out previous papers and relevant literature to assist the literature review and background research. Statistical Analysis Initially, data will be organized and entered using Microsoft Excel 2019 to review and clean preliminary data. The final analysis of the dataset will be through the utilization of IBM SPSS Statistics Version 26. Descriptive statistical methods will summarize the characteristics of the study population and their respective factors related to trauma. Continuous variables will be presented through mean and standard deviation (SD) for normally distributed and median with interquartile ranges (IQRs) when not normally distributed. Categorical variables will be presented as frequencies and percentages. For the comparison of groups, different statistical tests will differ depending on the type and distribution of data. Continuous variables with normal distribution were analyzed using the Student's t-test (for two groups) or One-way ANOVA (for more than two groups). The Mann-Whitney U test (for two groups) or the Kruskal-Wallis test (for more than two groups) will be used for continuous, non-normally distributed variables. Nominal (categorical) variables will be compared using the Chi-square (χ²) test. Area Under Curve Receiver Operating Characteristics (AUROC) will be designed to assess the predictive performance of the Revised Trauma Score (RTS) and the MGAP score for in-hospital mortality, ICU admission, and the requirement for surgical intervention. The various cutoff points will also have their sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) parameterized. Suitable methods, such as multiple imputation and sensitivity analysis, will handle cases of missing information for this research. With statistical analysis, 0.05 will be the p-value threshold below which it will be considered statistically significant. Discussion The rising incidence of trauma in Iraq, mainly due to road traffic accidents (RTAs) and injuries sustained from falls from heights and other forms of trauma, calls for the immediate establishment of efficient trauma management measures. The increase in burden due to trauma has been accompanied by a marked clinical gap in the application of trauma scoring systems in the emergency departments (ED) and hospitals. Such a gap leads to resource allocation, clinical decision-making hindrances, mortality prediction for ICU admission ranking, and morbidity risk estimations. Therefore, the study aims to bridge this gap by evaluating and comparing the predictive ability of the Revised Trauma Score (RTS) and the MGAP Score concerning gross trauma patients. Limitations Several limitations of this study should be considered while interpreting its findings. The single-center design limits the generalizability of the results to other hospitals or regions in the Iraqi setting or to other healthcare systems that work with different resource availability. Besides, variation in clinical experience and quality of treatment among other providers may bias the results. Sometimes, inappropriate follow-up and monitoring of the patient may also weaken the credibility of the mortality prediction models, as continuous evaluation is very important for trauma care. Drug unavailability, unavailability of equipment, lack of technology for adequate management, etc., will also influence the study. Such limitations might affect the outcome of the patients and the generalization of trauma scoring systems. Decisions regarding patients' admission to the ICU may also be flawed; full beds or absent free beds may lead to inappropriate admissions or deny care to patients truly in need. Lack of pre-hospital treatment due to limited ambulance services or delay in reaching the hospital would, on occasion, adversely affect the condition of trauma patients on arrival and thus interfere with the outcome of the study and the predictive accuracy of the trauma scores. Future Research Directions Future research in the region should aim to overcome the limitations described in this study, particularly by turning it into a multicenter study. Besides increasing the generalizability of the results, a multicenter study involving several hospitals across Iraq or in other regions facing similar health challenges would give a full appreciation of the predictive accuracy of trauma scores in various situations. Longitudinal studies looking at trauma patients starting from the time of injury until discharge and later would clarify the long-term value of trauma scores. Such studies would assist in additional validation of trauma scoring systems and explore possible influences on long-term survival and quality of life. Another area of consideration would be the limitations of the trauma scoring systems in settings where resources are constrained, always bearing in mind the health sector-related infrastructure—the availability of ambulances, allocation of resources in hospitals, and ICU capacity. Lastly, future studies should evaluate the cost-effectiveness of implementing trauma scoring systems in resource-constrained settings. Determining whether these tools lead to better outcomes without overwhelming healthcare resources would be crucial for their adoption in low—and middle-income countries. Work with Missing Data Missing data is a significant problem in studies that use trauma scores to predict patient outcomes. Incomplete injury characteristics or clinical parameters cause trauma scores to be underestimated, so all such cases are excluded. In addition, if follow-up data are missing, such cases should also be excluded, as assessing consequences is critical to the study's conclusions. Missing data regarding sociodemographic variables or other factors that do not affect trauma score calculations will undergo multiple imputation and sensitivity analysis techniques to correct the bias inherent in handling the missing data and form a very sound analysis. The goal is to ensure that such missing data does not skew the study results or change the trauma scores' predictive validity. Regular audits will be done alongside data validation processes while collecting data to minimize the chances of missing data. This will ensure that the collected data is complete and accurate, thus reducing the probability of missing data that could compromise the study findings. Proper handling of missing data ensures the integrity of such a study and leads to appropriate conclusions. What Is Already Known and What This Study Adds Studies before our own have established an important area of research that trauma scoring systems, such as the RTS and MGAP Score, can perform the task of trying to predict the mortality of patients in trauma. Over the years, these scoring systems have been validated in very different clinical surroundings, providing clinicians with an orderly approach to assess the severity of the trauma under consideration and thereby guide decisions for patient management. The earlier work has shown distinct applications of these scores in different regions and healthcare systems. Besides a handful of limited studies, however, there is sparse literature available on the use and predictive power of these trauma scoring systems in low- and middle-income countries such as Iraq, particularly for periods when healthcare resources might be scarce, thus creating a heavier burden of trauma. Many studies have pointed to high-income countries or ignored the challenges encountered by the healthcare systems in resource-poor settings. Again, a few studies directly compared RTS and MGAP Scores amongst trauma populations, where Iraq remains the prime example, being a nation that bears completely distinct characteristics from those of the high-income countries in terms of both health care system and trauma epidemiology. Thus, this study serves as an addition to the current literature through the evaluation and comparison of the predictive accuracy of both RTS and MGAP Score among multiple trauma patients in Iraq. The study introduces critical new insights into the effectiveness of these scoring systems for mortality prediction and their integration into clinical practice in resource-limited environments by their active use in a tertiary care hospital setting. The research underlined the need for trauma management tools contextualizing our environment's local problems. It will be the foundation for enhancing patient triage, resource allocation, and overarching trauma care in similar settings. Impact on Healthcare System An important area in which the findings of this study can be applied is the healthcare system, particularly as it relates to the management of trauma patients in resource-constrained settings, such as those in Iraq. In emergency departments (EDs) characterized by overcrowding and high patient loads, prompt and effective sorting of patients is essential for resuscitating even high-risk cases promptly and appropriately. Trauma scoring systems such as the Revised Trauma Score (RTS) and the MGAP Score could render swift decision-making possible and allow providers to prioritize patients based on mortality risk. These scores provide a reliable means of predicting patient outcomes. This, in turn, gives emergency departments an essential tool in allocating limited resources. It will ensure that those patients in greatest danger of dying are treated with the utmost urgency and intensive care. In so many countries, especially in the Third World, where the availability of ICU beds and medical personnel is often in short supply, helping to identify these high-risk patients will be vital in extracting the maximum effectiveness from the limited resources available. The prompt identification and prioritization of such cases, which tend to carry a high mortality risk, will prevent delays in life-saving interventions. This study could lead to more effective trauma care protocols that optimize resource use in emergency departments while ensuring that those in grave need of care are attended to. In turn, this will improve the overall quality and efficiency of trauma care in economies with inadequate resources, equipping such healthcare systems better to handle high patient volumes in times of crisis. Clinical Implications These research results have significant ramifications for the clinical care of traumatic events. The use of trauma-acid scoring systems like the Revised Trauma Score (RTS) and the MGAP Score may considerably boost clinical decision-making in the emergency department because these scores will allow one to predict mortality in case of injury with the utmost reliability. Effective identification of high-risk patients who would require immediate and intensive care will ensure that timely, life-critical intervention is instituted, improving survival rates. These scoring systems can improve the efficiency of trauma care by guiding triage decisions and prioritizing patients based on their mortality risk, particularly in overcrowded and resource-constrained settings. Clinicians can make more informed decisions regarding ICU admissions, reducing unnecessary resource use for low-risk patients and ensuring that those most in need receive appropriate critical care. Abbreviations RTS Revised Trauma Score MGAP Mechanism, Glasgow Coma Scale, Age, and Systolic Blood Pressure DALYS disability–adjusted life years LMICs low–and middle–income countries ORCID Open Researcher and Contributor ID ICU Intensive Care Unit IBM International Business Machines Corporation SPSS Statistical Package for the Social Sciences GCS Glasgow Coma Scale YLL Years of Life Lost CFR Case Fatality Rate AIS Abbreviated Injury Scale ISS Injury Severity Score NISS New Injury Severity Score PHI Pre–Hospital Index TRISS Trauma and Injury Severity Score NTRISS New Trauma and Injury Severity Score SBP Systolic Blood Pressure RR Respiratory Rate ED Emergency Department ER Emergency Room IRB Institutional Review Board CC Chief Complaint FFH Falls From Height PR Pulse Rate O₂% Oxygen Saturation HF Heart Failure CKD Chronic Kidney Disease HTN Hypertension DM Diabetes Mellitus HIV/ AIDS Human Immunodeficiency Virus Na Sodium K Potassium Ca²⁺ Calcium BUN Blood Urea Nitrogen Hb Hemoglobin WBC White Blood Cell AST Aspartate Aminotransferase ALT Alanine Aminotransferase U/S Ultrasound CT Computed Tomography BP Blood Pressure DVT Deep Vein Thrombosis ARDS Acute Respiratory Distress Syndrome AKI Acute Kidney Injury UNCOMIRB20250382 Unique IRB Approval ID (for Al–Nahrain University) NCT06744985 ClinicalTrials.gov Registration ID ChatGPT Chat Generative Pre–trained Transformer SD Standard Deviation IQR Interquartile Range ANOVA Analysis of Variance AUROC Area Under Curve Receiver Operating Characteristics PPV Positive Predictive Value NPV Negative Predictive Value RTA Road Traffic Accident GAP Glasgow Coma Scale, Age, and Systolic Blood Pressure CPG Clinical Practice Guideline WHO World Health Organization Declarations Ethical approval The study titled "Comparative Evaluation of the Revised Trauma Score and MGAP Score for Mortality Prediction in Multiple Trauma Patients: Protocol for a Prospective Observational Study" was approved by the Research Ethics Committee of the College of Medicine, Al-Nahrain University (Approval No. UNCOMIRB20250382), with approval granted from March 7, 2025, to March 7, 2027. Verbal informed consent was obtained from all participants prior to inclusion in the study. The ethics committee approved the use of verbal consent due to the study's observational nature and ensured that no personal or identifiable patient data were collected or disclosed. Consent for publication: Not applicable. This study relied solely on anonymized statistical analysis of trauma scoring systems without involving any identifiable patient data. Availability of data and materials: The datasets generated and analyzed during the current study are not publicly available due to the nature of the verbal consent obtained from participants. However, data may be made available from the corresponding author upon reasonable request and with appropriate ethical justification. Competing interests: The authors and co-authors of this study declare that they have no competing interests, including financial ties, sponsorships, or industry involvement. Funding: The authors declare that no funding was received for this study. All data were obtained from patient files with verbal consent, which was approved by the ethics committee. Authors' contributions: Dr. Bashar A. Abdulhassan (Assistant Professor of General Surgery) supervised the study, oversaw the data collection process, and reviewed and critically revised the manuscript. Dr. Hasan Naeem Kareem (Lecturer) contributed to data collection and manuscript writing. Dr. Salim K. Hajwal (Lecturer) contributed to data collection and manuscript writing. Dr. Osama N. Htitani (M.B.Ch.B) contributed to data collection, protocol development and manuscript writing. Dr. Jaafar Bashar Abass (M.B.Ch.B) contributed to data collection and manuscript writing. Dr. Abdulillh R. Khamess (Medical Student) contributed to study conception and design, data collection, data analysis and statistics, and manuscript writing. Dr. Ahmed K. Elishehaby (Medical Student) contributed to data collection, protocol development and manuscript writing. Dr. Hassan H. ElAdl (Medical Student) contributed to data collection, protocol development and manuscript writing. All authors read and approved the final manuscript. Acknowledgements: The authors thank the College of Medicine, Al-Nahrain University, for supporting this study. Special thanks to Prof. Dr. Anees Khalil Nayel, Dean of the College of Medicine, Al-Nahrain University, and all the nursing staff, medical personnel, and technical staff at the Trauma Center of Al-Nahrain Teaching Hospital for their valuable assistance. References World Health Organization. Injury and violence: the facts. Geneva: WHO; 2020. Junaid AR, Junaid B, Kate W, Mulinda N, Muhammad Ramzan T, Adnan AH: Improvement in trauma care for road traffic injuries: an assessment of the effect on mortality in low-income and middle-income countries . The Lancet 2022, 400 (10348):329-336. Ahmed SK, Mohammed MG, Abdulqadir SO, El-Kader RGA, El-Shall NA, Chandran D, Rehman MEU, Dhama K: Road traffic accidental injuries and deaths: A neglected global health issue . Health Sci Rep 2023, 6 (5):e1240. Peralta-Santos A, Gimbel S, Sorensen R, Covele A, Kawakatsu Y, Wagenaar BH, Augusto O, Ásbjörnsdóttir KH, Gloyd SS, Cuembelo F et al : The neglected epidemic-Risk factors associated with road traffic injuries in Mozambique: Results of the 2016 INCOMAS study . PLOS Glob Public Health 2022, 2 (2):e0000163. Shanthakumar D, Payne A, Leitch T, Alfa-Wali M: Trauma Care in Low- and Middle-Income Countries . Surg J (N Y) 2021, 7 (4):e281-e285. Murad MK, Issa DB, Mustafa FM, Hassan HO, Husum H: Prehospital trauma system reduces mortality in severe trauma: a controlled study of road traffic casualties in Iraq . Prehosp Disaster Med 2012, 27 (1):36-41. Kotwal RS, Scott LLF, Janak JC, Tarpey BW, Howard JT, Mazuchowski EL, Butler FK, Shackelford SA, Gurney JM, Stockinger ZT: The effect of prehospital transport time, injury severity, and blood transfusion on survival of US military casualties in Iraq . J Trauma Acute Care Surg 2018, 85 (1S Suppl 2):S112-s121. Chiniard T, Boutonnet M, Duron S, Bertho K, Travers S, Pasquier P: Profile of injuries in recent warfare . Journal of Trauma and Acute Care Surgery 2023, 95 (2S):S79-S87. Daebes HL, Tounsi LL, Nerlander M, Gerdin Wärnberg M, Jaweed M, Mamozai BA, Nasim M, Trelles M, von Schreeb J: Association between triage level and outcomes at Médecins Sans Frontières trauma hospital in Kunduz, Afghanistan, 2015 . Emerg Med J 2022, 39 (8):628-633. Chen CH, Shin SD, Sun JT, Jamaluddin SF, Tanaka H, Song KJ, Kajino K, Kimura A, Huang EP, Hsieh MJ et al : Association between prehospital time and outcome of trauma patients in 4 Asian countries: A cross-national, multicenter cohort study . PLoS Med 2020, 17 (10):e1003360. Bedard AF, Mata LV, Dymond C, Moreira F, Dixon J, Schauer SG, Ginde AA, Bebarta V, Moore EE, Mould-Millman N-K: A scoping review of worldwide studies evaluating the effects of prehospital time on trauma outcomes . International Journal of Emergency Medicine 2020, 13 (1):64. Beuran M, Negoi I, Păun S, Runcanu A, Gaspar B, Vartic M: [Trauma scores: a review of the literature] . Chirurgia (Bucur) 2012, 107 (3):291-297. Roy N, Gerdin M, Schneider E, Kizhakke Veetil DK, Khajanchi M, Kumar V, Saha ML, Dharap S, Gupta A, Tomson G et al : Validation of international trauma scoring systems in urban trauma centres in India . Injury 2016, 47 (11):2459-2464. Orhon R, Eren SH, Karadayı S, Korkmaz I, Coşkun A, Eren M, Katrancıoğlu N: Comparison of trauma scores for predicting mortality and morbidity on trauma patients . Ulus Travma Acil Cerrahi Derg 2014, 20 (4):258-264. Soni KD, Mahindrakar S, Gupta A, Kumar S, Sagar S, Jhakal A: Comparison of ISS, NISS, and RTS score as predictor of mortality in pediatric fall . Burns Trauma 2017, 5 :25. Kahloul M, Bouida W, Boubaker H, Toumi S, Grissa MH, Jaafar A, Louzi M, Boukef R, Gahbiche M, Nouira S: Value of anatomic and physiologic scoring systems in outcome prediction of trauma patients . Eur J Emerg Med 2014, 21 (2):125-129. Kingston R, O'Flanagan SJ: Scoring systems in trauma . Ir J Med Sci 2000, 169 (3):168-172. Chawda MN, Hildebrand F, Pape HC, Giannoudis PV: Predicting outcome after multiple trauma: which scoring system? Injury 2004, 35 (4):347-358. Jeong TS, Choi DH, Kim WK: The Relationship Between Trauma Scoring Systems and Outcomes in Patients With Severe Traumatic Brain Injury . Korean J Neurotrauma 2022, 18 (2):169-177. Khavandegar A, Salamati P, Zafarghandi M, Rahimi-Movaghar V, Sharif-Alhoseini M, Fakharian E, Saeed-Banadaky SH, Hoseinpour V, Sadeghian F, Nasr Isfahani M et al : Comparison of nine trauma scoring systems in prediction of inhospital outcomes of pediatric trauma patients: a multicenter study . Scientific Reports 2024, 14 (1):7646. Champion HR, Sacco WJ, Carnazzo AJ, Copes W, Fouty WJ: Trauma score . Crit Care Med 1981, 9 (9):672-676. Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME: A revision of the Trauma Score . J Trauma 1989, 29 (5):623-629. Baghi I, Shokrgozar L, Herfatkar MR, Nezhad Ehsan K, Mohtasham Amiri Z: Mechanism of Injury, Glasgow Coma Scale, Age, and Systolic Blood Pressure: A New Trauma Scoring System to Predict Mortality in Trauma Patients . Trauma Mon 2015, 20 (3):e24473. Mohammed Z, Saleh Y, AbdelSalam EM, Mohammed NBB, El-Bana E, Hirshon JM: Evaluation of the Revised Trauma Score, MGAP, and GAP scoring systems in predicting mortality of adult trauma patients in a low-resource setting . BMC Emerg Med 2022, 22 (1):90. Sartorius D, Le Manach Y, David JS, Rancurel E, Smail N, Thicoïpé M, Wiel E, Ricard-Hibon A, Berthier F, Gueugniaud PY et al : Mechanism, glasgow coma scale, age, and arterial pressure (MGAP): a new simple prehospital triage score to predict mortality in trauma patients . Crit Care Med 2010, 38 (3):831-837. Gilpin DA, Nelson PG: Revised trauma score: a triage tool in the accident and emergency department . Injury 1991, 22 (1):35-37. Jokšić-Mazinjanin R, Marić N, Đuričin A, Gojković Z, Vasović V, Rakić G, Jokšić-Zelić M, Saravolac S: Prehospital Trauma Scoring Systems for Evaluation of Trauma Severity and Prediction of Outcomes . Medicina (Kaunas) 2023, 59 (5). Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6597313","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Study protocol","associatedPublications":[],"authors":[{"id":457299854,"identity":"3a4f0f2e-2a25-40e0-a684-58f4cb5d8bb8","order_by":0,"name":"Bashar A. Abdulhassan","email":"","orcid":"","institution":"Al-Nahrain college of medicine","correspondingAuthor":false,"prefix":"","firstName":"Bashar","middleName":"A.","lastName":"Abdulhassan","suffix":""},{"id":457299855,"identity":"d588da18-0049-41e8-a6ab-52c5e31f9e0c","order_by":1,"name":"Abdulillh R. Khamess","email":"","orcid":"","institution":"Al-Nahrain college of medicine","correspondingAuthor":false,"prefix":"","firstName":"Abdulillh","middleName":"R.","lastName":"Khamess","suffix":""},{"id":457299856,"identity":"3e739cf8-c5a2-43aa-a8fa-69fa3d698547","order_by":2,"name":"Hassan. H. Eladl","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABA0lEQVRIiWNgGAWjYBACfmbGxsd/DGyAzASo0AECWiTbm5sNeArSSNBicOZ4mwDPh8MkaGG4kdjGIGFwPpqfPYHx4882Bjm+GwmMD7/g0cE4I7HtgYHB7dyZPQ+YpXnbGIwlbyQwG8vg0cIskdhukADUsuFGAoM0YxtDIpDBJi2BRwubRGKbxAGDc7n7gYb/BDqsHqiF/Tc+LTw8B9skGwwO5G6QSGCTADoswQBoC+MHPFok2BubjRkMknNnnHnYZs1zTsJw5pmHzdJ4dDDYH2Z/+Jjhj11uf3vy4Zs/ymzk+Y4nH/z4A58eBGBsANkKZjDzEKcFWTeRtoyCUTAKRsHIAAA7kFLuHVRgngAAAABJRU5ErkJggg==","orcid":"","institution":"Ain Shams University","correspondingAuthor":true,"prefix":"","firstName":"Hassan.","middleName":"H.","lastName":"Eladl","suffix":""},{"id":457299857,"identity":"2e8609f1-9316-4ea1-8548-78e671a8cf42","order_by":3,"name":"Osama N. Htitani","email":"","orcid":"","institution":"Beni _ Suif University","correspondingAuthor":false,"prefix":"","firstName":"Osama","middleName":"N.","lastName":"Htitani","suffix":""},{"id":457299858,"identity":"7bc30a14-0ac5-4fd9-a07e-0da3353954ab","order_by":4,"name":"Ahmed K. Elishehaby","email":"","orcid":"","institution":"Banha University","correspondingAuthor":false,"prefix":"","firstName":"Ahmed","middleName":"K.","lastName":"Elishehaby","suffix":""},{"id":457299859,"identity":"52438de7-aebd-4ced-a4bf-25677641df51","order_by":5,"name":"Hasan Naeem Kareem","email":"","orcid":"","institution":"Al-Qadisiyah University","correspondingAuthor":false,"prefix":"","firstName":"Hasan","middleName":"Naeem","lastName":"Kareem","suffix":""},{"id":457299860,"identity":"b9d611dd-25e6-4e77-8b87-eb9cdf370f71","order_by":6,"name":"Salim K. Hajwal","email":"","orcid":"","institution":"Al-Mustaqbal University","correspondingAuthor":false,"prefix":"","firstName":"Salim","middleName":"K.","lastName":"Hajwal","suffix":""},{"id":457299861,"identity":"20436479-59d6-4b58-87b6-1cc60c79516e","order_by":7,"name":"Jaafar Bashar Abass","email":"","orcid":"","institution":"Al-Nahrain college of medicine","correspondingAuthor":false,"prefix":"","firstName":"Jaafar","middleName":"Bashar","lastName":"Abass","suffix":""}],"badges":[],"createdAt":"2025-05-05 20:53:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6597313/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6597313/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":82898679,"identity":"5f734cb4-40d8-4138-9f31-ab66b7b973eb","added_by":"auto","created_at":"2025-05-16 13:12:56","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":507758,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6597313/v1/6dfc91ab885eaf7c867226c4.jpeg"},{"id":83507247,"identity":"7c538215-ed5d-4804-9993-53f080a88bd6","added_by":"auto","created_at":"2025-05-27 15:16:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2488758,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6597313/v1/f3826e5b-0b60-4b0f-b3b0-a8f57b8400cc.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparative Evaluation of the Revised Trauma Score and MGAP Score for Mortality Prediction in Multiple Trauma Patients: Protocol for a Prospective Observational Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eTrauma presents a significant global health threat, being the sixth leading cause of death and the fifth leading cause of moderate to severe disability worldwide, because it causes more than 4.4\u0026nbsp;million yearly deaths and generates 10% of global disability-adjusted life years (DALYS) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Road traffic accidents (RTAs) and falls, together with interpersonal violence and conflict-related injuries, serve as the primary mechanisms for fatalities, while RTAs specifically result in 1.3\u0026nbsp;million annual deaths that primarily influence low- and middle-income nations (LMICs) [2\u0026ndash;4]. In low- and middle-income countries, the trauma-related death rates are three times higher than in high-income countries due to inadequate prehospital care, restricted emergency service availability, and limited resources [5].\u003c/p\u003e \u003cp\u003eTrauma-related health problems in Iraq have become worse due to long-running fighting, along with structural issues and limited medical care capabilities. Traumatic injuries cause 22% of all deaths across the nation, while road traffic accidents (RTAs) represent 35% of trauma cases, blast injuries follow with 28%, and interpersonal violence at 15% [6, 7]. Trauma injuries resulting from conflicts often lead to severe cases because patients experience prolonged delays to care and have intricate damage patterns from polytrauma [8]. Prehospital care delays, experienced by over 40% of trauma patients in conflict-affected regions, contribute to significantly worse outcomes, including an 18% pre-hospital mortality rate [9, 10]. These delays are exacerbated by critical resource limitations, such as shortages of imaging tools, blood products, and intensive care facilities, which hinder the implementation of modern trauma treatment protocols, particularly in rural and war-torn areas [9, 11]. The systemic problems in Iraq require immediate development of tailored triage instruments to reflect the specialised trauma statistics and healthcare structure authentic to Iraq's nation.\u003c/p\u003e \u003cp\u003eScoring systems are categorized into anatomical, physiological, or combined types [12, 13]. The AIS, ISS, and NISS are anatomical scoring systems based on different anatomical factors, including the location and severity of injuries [14\u0026ndash;16]. In contrast, The GCS, RTS, and PHI are scoring systems based on physiological data collected during physical exams [16]. Additionally, the TRISS, NTRISS, and TRISS are integrated scoring systems that include both anatomical and physiological features of trauma [17\u0026ndash;20].\u003c/p\u003e \u003cp\u003eThe RTS (Revised Trauma Score) is a physiological scoring system used to assess trauma patients. Initially developed and evaluated through a study involving over 2,000 individuals, the RTS includes three essential physiological indicators: the Glasgow Coma Scale (GCS), Systolic Blood Pressure (SBP), and Respiration Rate (RR) [21, 22].\u003c/p\u003e \u003cp\u003eMGAP is a physiological score that has been developed to predict survival outcomes in individuals experiencing trauma. Although it has been validated in research settings, it remains underutilized in low- and middle-income regions, despite its promise and practicality. MGAP stands for the mechanism of injury (M), Glasgow Coma Scale (G) score, patient age (A), and systolic blood pressure (P). This scoring system was validated in France for its effectiveness in predicting 30-day mortality [23\u0026ndash;25].\u003c/p\u003e \u003cp\u003eThis study seeks to evaluate the diagnostic accuracy of the Revised Trauma Score (RTS) compared to MGAP in assessing the clinical outcomes of multiple trauma patients admitted to a trauma center.\u003c/p\u003e"},{"header":"Objectives","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePrimary Objective:\u003c/h2\u003e \u003cp\u003eThis study aims to assess and compare the predictive accuracy of the Revised Trauma Score (RTS) and the MGAP Score in predicting in-hospital mortality for multiple trauma patients admitted to the emergency department.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSecondary Objectives:\u003c/h3\u003e\n\u003cp\u003eTo evaluate and compare the accuracy of the Revised Trauma Score (RTS) and MGAP Score in predicting the need for ICU admission.\u003c/p\u003e \u003cp\u003eTo assess the predictive accuracy of both scores in identifying patients who require surgical intervention.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n\u003ch2\u003eStudy Design\u003c/h2\u003e\n\u003cp\u003eThis prospective observational study will assess and compare the predictive accuracy of the Revised Trauma Score (RTS) and the MGAP Score for in-hospital mortality, ICU admission, and the need for surgical intervention among multiple trauma patients from March to November 2025.\u003c/p\u003e\n\u003cp\u003eThis study represents part of Phase I of the Iraqi Trauma Score Project: A Multi-Phase National Study on Outcomes Prediction. This extensive multi-center nationwide project aims to compare the performance and predictive accuracy of various trauma scoring systems in Iraq. Phase I is currently in progress at the Emergency Department of Al-Kadhimiya Teaching Hospital. It will expand to include Phase II, which will take the study beyond the borders of Baghdad and into four major trauma centers in the capital. Phase III will consist of multiple trauma centers spread across different provinces. The phased design aims for a thorough and regionally representative evaluation of trauma score effectiveness across various clinical settings.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eStudy Setting\u003c/h3\u003e\n\u003cp\u003eThis study will be conducted at Al-Imamayn Al-Kadhimayn Medical City (mostly referred to as Al-Kadhimiya Teaching Hospital), located at Kadhimiya, a historic district in Baghdad, Iraq. The hospital is one of the country's largest and busiest tertiary care centers. It provides various specialized medical and surgical services, including emergency and trauma care. It serves as a highly rated and significant referral center for northern Baghdad and surrounding areas experiencing significantly increased volumes of trauma cases associated with road traffic accidents, falls, and violence-related injuries.\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n\u003ch2\u003eSample Size\u003c/h2\u003e\n\u003cp\u003eThe sample will include all cases of multiple traumas that come to the emergency department of Kadhimiya Teaching Hospital during the data-gathering period. There will be no explicit sample size calculation as this is a prospective observational study aimed at including a consecutive sample of eligible patients to reflect real-world emergency department presentations.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eStudy Population\u003c/h3\u003e\n\u003cp\u003ePatients aged\u0026thinsp;\u0026ge;\u0026thinsp;16 years who presented with multiple traumas to the emergency department during the study period will be included as a study population. Multiple trauma is defined as injuries involving two or more body regions or organ systems that might need coordinated multidisciplinary management. Patients will include both males and females, and a variety of kinds of trauma mechanisms will be involved in the study, including road traffic accidents, falls from height, and violence-associated injuries that are familiar sources of trauma in Iraq.\u003c/p\u003e\n\u003ch3\u003eInclusion Criteria\u003c/h3\u003e\n\u003cp\u003e1- Aged 16 years or older.\u003c/p\u003e\n\u003cp\u003e2- Presented with multiple trauma\u003c/p\u003e\n\u003cp\u003e3- Complete clinical data will be available at the presentation.\u003c/p\u003e\n\u003cp\u003e4- Provided informed consent (or consent obtained from a relative or legal representative if the patient is unable to consent due to clinical condition).\u003c/p\u003e\n\u003cp\u003e5- Capability to assess outcomes such as survival, ICU admission, and complications.\u003c/p\u003e\n\u003cp\u003e6- Presentation to the trauma center within 6 hours of injury.\u003c/p\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n\u003ch2\u003eExclusion Criteria\u003c/h2\u003e\n\u003cp\u003e1- Transfers from other facilities with interventions that could impact RTS or MGAP reliability.\u003c/p\u003e\n\u003cp\u003e2- Patients who expired before scoring or evaluation\u003c/p\u003e\n\u003cp\u003e3- Pregnant patients, due to the unique considerations of trauma in pregnancy.\u003c/p\u003e\n\u003cp\u003e4- Burn injuries as the primary trauma mechanism.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n\u003ch2\u003eData Collections\u003c/h2\u003e\n\u003cp\u003eAll data collection commenced after the study's approval by the Institutional Review Board at the College of Medicine\u0026mdash;Al-Nahrain University and study registration on ClinicalTrials.gov. It will be organized into two separate phases: the first phase in the Emergency Department (ED) and the second phase during follow-up in the hospital surgical wards or Intensive Care Unit (ICU), as shown in \u003cstrong\u003eFig.\u0026nbsp;1\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDuring the first phase, trauma patients will be assessed by trained data collectors upon arrival in the ER. Clinical parameters will be recorded as initial assessment parameters regarding vitals, level of consciousness, and sociodemographic variables such as age, sex, height, and weight. Trauma-related factors will also be recorded, including the date and time of trauma, location of injury, type of trauma, mechanism of injury, and mode of transport to the hospital. Previous medical history, initial investigations, laboratory and imaging, and full-body examination findings will be noted. All variables used to calculate the Revised Trauma Score (RTS) and MGAP score will be collected meticulously. The need for timely or urgent surgical or procedural intervention, blood transfusion, ICU admission, and mechanical ventilation, as well as any complications or deaths that occurred in the emergency department, will be noted.\u003c/p\u003e\n\u003cp\u003eIn the second phase, the same patients will be followed up during their hospital stay in the ward or ICU until discharge to home or death to monitor clinical progress and outcomes. Daily follow-ups will be done for all patients in the ICU and surgical wards to monitor vital signs, need for surgical intervention, blood transfusion, ICU transfer (if initially admitted to the ward), complications, and the outcome, including being discharged or death. All consequent events will be meticulously recorded, including actual dates and times of ICU admission, surgical procedures, discharge from the hospital, and death.\u003c/p\u003e\n\u003cp\u003eInformation will be stored in a secure electronic database system, and anonymized patient codes will protect the confidentiality of their information. Quality control methods include periodic audits and data entry validation during the entire data collection process. For purposes of data validation and consistency, all data collectors underwent a standardized 7-day training program conducted by two professors in the fields of surgery and emergency medicine. Training will be imparted in clinical evaluation methods, ethics, and standard forms for documentation. At every step, the process will be conducted with adherence to IRB-mandated guidelines. To avoid fatigue-related errors, possibly giving rise to bias, the data collectors worked only one day per week throughout the study.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n\u003ch2\u003eIndependent Variables\u003c/h2\u003e\n\u003cp\u003eThe independent variables in this study include an exhaustive list of sociodemographic, clinical, and trauma-related information drawn at the first assessment in the Emergency Room (ER) and a series of subsequent follow-ups in the surgical wards or the ICU.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n\u003ch2\u003eVariables collected in the ER included:\u003c/h2\u003e\n\u003cp\u003eSociodemographic: age of the patient, sex (male or female), height in centimeters, and weight in kilograms. Dates and times of trauma, day of injury, places where the injury happened, and specific injury details will be trauma-specific information recorded at the presentation. Clinical aspects of the trauma will be thoroughly documented: chief complaint (C.C.) and its duration; type of trauma characterized as blunt or penetrating, or both; and mechanism of injury, which could include road traffic accident (RTA), falls from height (FFH), gunshot wounds, motorcycle-related injuries, or knife injuries.\u003c/p\u003e\n\u003cp\u003eInitial vital signs included blood pressure (systolic/diastolic), respiratory rate (RR), pulse rate (PR), temperature, oxygen saturation (O₂%), and glucose level. Capillary refill time will also be assessed as an indicator of peripheral perfusion. The level of consciousness, as measured by Glasgow Coma Scale (GCS) scores, will be additionally documented. These parameters will be vital for calculating the Revised Trauma Score (RTS) and MGAP Score.\u003c/p\u003e\n\u003cp\u003eHistory in detail, past medical involving the presence of heart failure (HF), chronic kidney disease (CKD), or hypertension (HTN), diabetes mellitus (DM), stroke condition, smoking status, alcohol consumption, cancer, cardiovascular diseases, acute renal failure, chronic liver disease, chronic respiratory disease, and immunosuppression, like HIV/AIDS or long-term steroid use, will be considered for their possible effect on trauma outcomes and mortality.\u003c/p\u003e\n\u003cp\u003eLaboratory investigations on admission included serum sodium (Na), potassium (K), calcium (Ca\u0026sup2;⁺), chloride (Cl), urea, serum creatinine, blood urea nitrogen (BUN), hemoglobin (Hb), hematocrit, white blood cell (WBC), platelet count, and liver function evaluated with levels of AST, ALT, total bilirubin, and direct bilirubin. Findings from the physical examination will be additionally documented in a structured form, including systems related to trauma assessment. These findings included abdominal, chest, cardiac, and rapid neurological examinations. Additional trauma-related injury analysis radiologically included X-ray, ultrasound (U/S), and CT scans, with all abnormal or significant findings contained in the patient's profile.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n\u003ch2\u003eFollow-up variables (in the Surgical Wards or ICU)\u003c/h2\u003e\n\u003cp\u003eDuring the whole period of hospitalization in either intensive care (ICU) or surgical wards, all follow-up variables will be carefully recorded for observation of patient status and, especially, for obtaining essential clinical outcomes. Complete daily vital signs will be recorded for BP, RR, PR, and O₂ saturation to note early trends or signs of deteriorating/increasing improvement. Value and outcome recording include the number and category of emergency or urgent surgical procedures done on the patient and whether the patient died in surgery. Date, time, and surgical duration. Blood transfusions during ward stay will also be documented, and how many blood bags will be used.\u003c/p\u003e\n\u003cp\u003eComplications will be extensively assessed during hospitalization, such as chest infection, ileus, deep vein thrombosis (DVT), malnutrition, acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), hypotension or shock, imbalance in electrolytes, cardiac arrhythmias, pressure sores, stroke, anemia, sepsis, and stress ulcers. There will be documentation of complications to assess the burden of morbidity.\u003c/p\u003e\n\u003cp\u003eFurthermore, any subsequent need for admission to the ICU after the initial evaluation will be recorded. Outcomes, either discharge, ICU admission, or death, will be explicitly documented with exact dates and times. These independent variables will be collectively chosen to ensure a complete assessment of each patient's clinical status upon presentation and to facilitate comparative analyses of trauma severity scoring systems.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n\u003ch2\u003eScoring System\u003c/h2\u003e\n\u003cdiv id=\"Sec17\" class=\"Section3\"\u003e\n\u003ch2\u003eRevised Trauma Score (RTS)\u003c/h2\u003e\n\u003cp\u003eIt is a physiologic scoring system used to assess the severity of trauma based on a patient\u0026rsquo;s initial vital signs. It combines three parameters: Glasgow Coma Scale (GCS), systolic blood pressure (SBP), and respiratory rate (RR). Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eThe score ranges from 0 to approximately 7.84, where a lower score indicates more severe trauma and a higher mortality risk [21, 22]. The RTS is calculated using a weighted formula that emphasizes neurological status:\u003c/p\u003e\n\u003cp\u003eRTS\u0026thinsp;=\u0026thinsp;0.9368\u0026times;GCSscore\u0026thinsp;+\u0026thinsp;0.7326\u0026times;SBPscore\u0026thinsp;+\u0026thinsp;0.2908\u0026times;RRscore\u003cem\u003eRTS\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.9368\u0026times;\u003cem\u003eGCSscore\u003c/em\u003e\u0026thinsp;+\u0026thinsp;0.7326\u0026times;\u003cem\u003eSBPscore\u003c/em\u003e\u0026thinsp;+\u0026thinsp;0.2908\u0026times;\u003cem\u003eRRscore\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn triage systems, patients with RTS of 12 (sum of raw scores before weighting) may be labeled delayed, 11 urgent, and 3\u0026ndash;10 immediate; below 3 is usually considered non-survivable [22, 26].\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eParameters and Point Values Used in Calculating the Revised Trauma Score\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAssigned Numeric Value\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eGCS\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSBP\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eRR\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13\u0026ndash;15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026gt;\u0026thinsp;89\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10\u0026ndash;29\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9\u0026ndash;12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e76\u0026ndash;89\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026gt;\u0026thinsp;29\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6\u0026ndash;8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e50\u0026ndash;75\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6\u0026ndash;9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u0026ndash;5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u0026ndash;49\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u0026ndash;5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\n\u003ch2\u003eMechanism, Glasgow coma scale, Age, and Arterial pressure (MGAP) Score:\u003c/h2\u003e\n\u003cp\u003eA trauma scoring system was designed to predict mortality in trauma patients based on four variables: Mechanism of injury, Glasgow Coma Scale (GCS), Age, and arterial Pressure (systolic blood pressure). Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eIt is simple to calculate and useful for triage and prognosis prediction in trauma care. Total scores can range from 3 to 29, with a higher score predicting a better prognosis [24, 27]. A cutoff score of 22 is often used to distinguish higher risk, and it shows high sensitivity and specificity for mortality prediction [23, 25].\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eMGAP scoring systems and the corresponding points for each variable\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAssigned Numeric Value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eAge\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;60 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e+\u0026thinsp;5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026gt;\u0026thinsp;60 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eGCS Score\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e+\u0026thinsp;3\u0026ndash;15\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMechanism of trauma\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBlunt trauma\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e+\u0026thinsp;4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePenetrating trauma\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSBP\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026gt;\u0026thinsp;120 mmHg\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e+\u0026thinsp;5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e60\u0026mdash;120 mmHg\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e+\u0026thinsp;3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;60 mmHg\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\n\u003ch2\u003eOutcomes\u003c/h2\u003e\n\u003cdiv id=\"Sec20\" class=\"Section3\"\u003e\n\u003ch2\u003ePrimary Outcome:\u003c/h2\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003eIn-hospital mortality of multiple trauma patients. This refers to any death occurring during the initial evaluation in the emergency department, in theatre, or throughout the hospital stay in the ICU or surgical wards until discharge. Time Frame: In-Hospital Phase (average of 7 days to discharge)\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eAccuracy Assessment of the Revised Trauma Score (RTS): Total RTS score from 0 to about 12; the lower the score, the higher the injury and risk of mortality. Time Frame: the first 6 hours after ER admission\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eAccuracy Assessment of the MGAP score (mechanism, Glasgow coma scale, Age, and blood pressure). Total scores can range from 3 to 29, with a higher score predicting a better prognosis. Time Frame: the first 6 hours after ER admission\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\n\u003ch2\u003eSecondary Outcomes:\u003c/h2\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003eLength of Hospitalization: Length of stay beginning from admission and discharge of each patient; counts in days spent in surgical wards, ICU, and other departments for the treatment course. Time Frame: Up to discharge, an average of 7 days\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eICU Admission- The presence of marked clinical deterioration, serious complications, or need for advanced monitoring and life-support measures shall determine ICU admission. Time Frame: Up to discharge, an average of 7 days\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eSurgical Intervention: There is a need for surgical intervention during a trauma patient's hospital stay. Time Frame: Up to discharge, an average of 7 days\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eand Prospective Study Registration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Institutional Review Board (IRB) of the College of Medicine, Al-Nahrain University, under approval ID: UNCOMIRB20250382. It will be conducted according to the ethical principles of the Declaration of Helsinki and local ethical guidelines. Also Registered Prospectively at ClinicalTrials.gov with Registration ID: NCT06744985.\u003c/p\u003e\n\u003cp\u003eEnrolled participants or their legal representatives (if the patient is unable to provide consent) will be verbally informed of the study's purpose, procedures, and confidentiality. Prior to commencing data collection, verbal informed consent will be elicited from every participant within the guidelines provided by the IRB, and this consent will be recorded appropriately in the study records.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\n\u003ch2\u003eArtificial Intelligence Disclosure Statement\u003c/h2\u003e\n\u003cp\u003eThis research study harnessed artificial intelligence tools in various research processes. ChatGPT, for example, was employed to check the manuscript for grammatical and spelling errors to ensure clarity and correctness. Moreover, SciSpace sought out previous papers and relevant literature to assist the literature review and background research.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec23\" class=\"Section2\"\u003e\n\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\n\u003cp\u003eInitially, data will be organized and entered using Microsoft Excel 2019 to review and clean preliminary data. The final analysis of the dataset will be through the utilization of IBM SPSS Statistics Version 26. Descriptive statistical methods will summarize the characteristics of the study population and their respective factors related to trauma. Continuous variables will be presented through mean and standard deviation (SD) for normally distributed and median with interquartile ranges (IQRs) when not normally distributed. Categorical variables will be presented as frequencies and percentages. For the comparison of groups, different statistical tests will differ depending on the type and distribution of data. Continuous variables with normal distribution were analyzed using the Student's t-test (for two groups) or One-way ANOVA (for more than two groups). The Mann-Whitney U test (for two groups) or the Kruskal-Wallis test (for more than two groups) will be used for continuous, non-normally distributed variables. Nominal (categorical) variables will be compared using the Chi-square (\u0026chi;\u0026sup2;) test. Area Under Curve Receiver Operating Characteristics (AUROC) will be designed to assess the predictive performance of the Revised Trauma Score (RTS) and the MGAP score for in-hospital mortality, ICU admission, and the requirement for surgical intervention. The various cutoff points will also have their sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) parameterized.\u003c/p\u003e\n\u003cp\u003eSuitable methods, such as multiple imputation and sensitivity analysis, will handle cases of missing information for this research. With statistical analysis, 0.05 will be the p-value threshold below which it will be considered statistically significant.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe rising incidence of trauma in Iraq, mainly due to road traffic accidents (RTAs) and injuries sustained from falls from heights and other forms of trauma, calls for the immediate establishment of efficient trauma management measures. The increase in burden due to trauma has been accompanied by a marked clinical gap in the application of trauma scoring systems in the emergency departments (ED) and hospitals. Such a gap leads to resource allocation, clinical decision-making hindrances, mortality prediction for ICU admission ranking, and morbidity risk estimations. Therefore, the study aims to bridge this gap by evaluating and comparing the predictive ability of the Revised Trauma Score (RTS) and the MGAP Score concerning gross trauma patients.\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eSeveral limitations of this study should be considered while interpreting its findings. The single-center design limits the generalizability of the results to other hospitals or regions in the Iraqi setting or to other healthcare systems that work with different resource availability. Besides, variation in clinical experience and quality of treatment among other providers may bias the results. Sometimes, inappropriate follow-up and monitoring of the patient may also weaken the credibility of the mortality prediction models, as continuous evaluation is very important for trauma care.\u003c/p\u003e \u003cp\u003eDrug unavailability, unavailability of equipment, lack of technology for adequate management, etc., will also influence the study. Such limitations might affect the outcome of the patients and the generalization of trauma scoring systems. Decisions regarding patients' admission to the ICU may also be flawed; full beds or absent free beds may lead to inappropriate admissions or deny care to patients truly in need. Lack of pre-hospital treatment due to limited ambulance services or delay in reaching the hospital would, on occasion, adversely affect the condition of trauma patients on arrival and thus interfere with the outcome of the study and the predictive accuracy of the trauma scores.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section2\"\u003e \u003ch2\u003eFuture Research Directions\u003c/h2\u003e \u003cp\u003eFuture research in the region should aim to overcome the limitations described in this study, particularly by turning it into a multicenter study. Besides increasing the generalizability of the results, a multicenter study involving several hospitals across Iraq or in other regions facing similar health challenges would give a full appreciation of the predictive accuracy of trauma scores in various situations.\u003c/p\u003e \u003cp\u003eLongitudinal studies looking at trauma patients starting from the time of injury until discharge and later would clarify the long-term value of trauma scores. Such studies would assist in additional validation of trauma scoring systems and explore possible influences on long-term survival and quality of life. Another area of consideration would be the limitations of the trauma scoring systems in settings where resources are constrained, always bearing in mind the health sector-related infrastructure\u0026mdash;the availability of ambulances, allocation of resources in hospitals, and ICU capacity.\u003c/p\u003e \u003cp\u003eLastly, future studies should evaluate the cost-effectiveness of implementing trauma scoring systems in resource-constrained settings. Determining whether these tools lead to better outcomes without overwhelming healthcare resources would be crucial for their adoption in low\u0026mdash;and middle-income countries.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section2\"\u003e \u003ch2\u003eWork with Missing Data\u003c/h2\u003e \u003cp\u003eMissing data is a significant problem in studies that use trauma scores to predict patient outcomes. Incomplete injury characteristics or clinical parameters cause trauma scores to be underestimated, so all such cases are excluded. In addition, if follow-up data are missing, such cases should also be excluded, as assessing consequences is critical to the study's conclusions.\u003c/p\u003e \u003cp\u003eMissing data regarding sociodemographic variables or other factors that do not affect trauma score calculations will undergo multiple imputation and sensitivity analysis techniques to correct the bias inherent in handling the missing data and form a very sound analysis. The goal is to ensure that such missing data does not skew the study results or change the trauma scores' predictive validity.\u003c/p\u003e \u003cp\u003eRegular audits will be done alongside data validation processes while collecting data to minimize the chances of missing data. This will ensure that the collected data is complete and accurate, thus reducing the probability of missing data that could compromise the study findings. Proper handling of missing data ensures the integrity of such a study and leads to appropriate conclusions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003eWhat Is Already Known and What This Study Adds\u003c/h2\u003e \u003cp\u003eStudies before our own have established an important area of research that trauma scoring systems, such as the RTS and MGAP Score, can perform the task of trying to predict the mortality of patients in trauma. Over the years, these scoring systems have been validated in very different clinical surroundings, providing clinicians with an orderly approach to assess the severity of the trauma under consideration and thereby guide decisions for patient management. The earlier work has shown distinct applications of these scores in different regions and healthcare systems.\u003c/p\u003e \u003cp\u003eBesides a handful of limited studies, however, there is sparse literature available on the use and predictive power of these trauma scoring systems in low- and middle-income countries such as Iraq, particularly for periods when healthcare resources might be scarce, thus creating a heavier burden of trauma. Many studies have pointed to high-income countries or ignored the challenges encountered by the healthcare systems in resource-poor settings. Again, a few studies directly compared RTS and MGAP Scores amongst trauma populations, where Iraq remains the prime example, being a nation that bears completely distinct characteristics from those of the high-income countries in terms of both health care system and trauma epidemiology.\u003c/p\u003e \u003cp\u003eThus, this study serves as an addition to the current literature through the evaluation and comparison of the predictive accuracy of both RTS and MGAP Score among multiple trauma patients in Iraq. The study introduces critical new insights into the effectiveness of these scoring systems for mortality prediction and their integration into clinical practice in resource-limited environments by their active use in a tertiary care hospital setting. The research underlined the need for trauma management tools contextualizing our environment's local problems. It will be the foundation for enhancing patient triage, resource allocation, and overarching trauma care in similar settings.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003ch2\u003eImpact on Healthcare System\u003c/h2\u003e \u003cp\u003eAn important area in which the findings of this study can be applied is the healthcare system, particularly as it relates to the management of trauma patients in resource-constrained settings, such as those in Iraq. In emergency departments (EDs) characterized by overcrowding and high patient loads, prompt and effective sorting of patients is essential for resuscitating even high-risk cases promptly and appropriately. Trauma scoring systems such as the Revised Trauma Score (RTS) and the MGAP Score could render swift decision-making possible and allow providers to prioritize patients based on mortality risk.\u003c/p\u003e \u003cp\u003eThese scores provide a reliable means of predicting patient outcomes. This, in turn, gives emergency departments an essential tool in allocating limited resources. It will ensure that those patients in greatest danger of dying are treated with the utmost urgency and intensive care. In so many countries, especially in the Third World, where the availability of ICU beds and medical personnel is often in short supply, helping to identify these high-risk patients will be vital in extracting the maximum effectiveness from the limited resources available.\u003c/p\u003e \u003cp\u003eThe prompt identification and prioritization of such cases, which tend to carry a high mortality risk, will prevent delays in life-saving interventions. This study could lead to more effective trauma care protocols that optimize resource use in emergency departments while ensuring that those in grave need of care are attended to. In turn, this will improve the overall quality and efficiency of trauma care in economies with inadequate resources, equipping such healthcare systems better to handle high patient volumes in times of crisis.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eClinical Implications\u003c/h3\u003e\n\u003cp\u003eThese research results have significant ramifications for the clinical care of traumatic events. The use of trauma-acid scoring systems like the Revised Trauma Score (RTS) and the MGAP Score may considerably boost clinical decision-making in the emergency department because these scores will allow one to predict mortality in case of injury with the utmost reliability. Effective identification of high-risk patients who would require immediate and intensive care will ensure that timely, life-critical intervention is instituted, improving survival rates.\u003c/p\u003e \u003cp\u003eThese scoring systems can improve the efficiency of trauma care by guiding triage decisions and prioritizing patients based on their mortality risk, particularly in overcrowded and resource-constrained settings. Clinicians can make more informed decisions regarding ICU admissions, reducing unnecessary resource use for low-risk patients and ensuring that those most in need receive appropriate critical care.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRTS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRevised Trauma Score\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMGAP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMechanism, Glasgow Coma Scale, Age, and Systolic Blood Pressure\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDALYS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003edisability\u0026ndash;adjusted life years\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLMICs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003elow\u0026ndash;and middle\u0026ndash;income countries\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eORCID\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOpen Researcher and Contributor ID\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eICU\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIntensive Care Unit\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIBM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInternational Business Machines Corporation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSPSS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStatistical Package for the Social Sciences\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eGCS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGlasgow Coma Scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eYLL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eYears of Life Lost\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCFR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCase Fatality Rate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAIS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAbbreviated Injury Scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eISS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInjury Severity Score\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNISS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNew Injury Severity Score\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePHI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePre\u0026ndash;Hospital Index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTRISS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTrauma and Injury Severity Score\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNTRISS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNew Trauma and Injury Severity Score\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSBP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSystolic Blood Pressure\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRespiratory Rate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eED\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEmergency Department\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eER\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEmergency Room\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIRB\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInstitutional Review Board\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eChief Complaint\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFFH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFalls From Height\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePulse Rate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eO₂%\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOxygen Saturation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHeart Failure\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCKD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eChronic Kidney Disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHTN\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDiabetes Mellitus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHIV/ AIDS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHuman Immunodeficiency Virus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNa\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSodium\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eK\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePotassium\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCa\u0026sup2;⁺\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCalcium\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBUN\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBlood Urea Nitrogen\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHb\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHemoglobin\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWBC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWhite Blood Cell\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAST\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAspartate Aminotransferase\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eALT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAlanine Aminotransferase\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eU/S\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUltrasound\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eComputed Tomography\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBlood Pressure\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDVT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDeep Vein Thrombosis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eARDS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAcute Respiratory Distress Syndrome\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAKI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAcute Kidney Injury\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUNCOMIRB20250382\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUnique IRB Approval ID (for Al\u0026ndash;Nahrain University)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNCT06744985\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eClinicalTrials.gov Registration ID\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eChatGPT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eChat Generative Pre\u0026ndash;trained Transformer\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStandard Deviation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIQR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInterquartile Range\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eANOVA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAnalysis of Variance\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAUROC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eArea Under Curve Receiver Operating Characteristics\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePPV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePositive Predictive Value\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNPV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNegative Predictive Value\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRTA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRoad Traffic Accident\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eGAP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGlasgow Coma Scale, Age, and Systolic Blood Pressure\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCPG\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eClinical Practice Guideline\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWorld Health Organization\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval\u003cbr\u003e\u003c/strong\u003eThe study titled \"Comparative Evaluation of the Revised Trauma Score and MGAP Score for Mortality Prediction in Multiple Trauma Patients: Protocol for a Prospective Observational Study\" was approved by the Research Ethics Committee of the College of Medicine, Al-Nahrain University (Approval No. UNCOMIRB20250382), with approval granted from March 7, 2025, to March 7, 2027.\u003cbr\u003e\u0026nbsp;Verbal informed consent was obtained from all participants prior to inclusion in the study. The ethics committee approved the use of verbal consent due to the study's observational nature and ensured that no personal or identifiable patient data were collected or disclosed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Not applicable. This study relied solely on anonymized statistical analysis of trauma scoring systems without involving any identifiable patient data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analyzed during the current study are not publicly available due to the nature of the verbal consent obtained from participants. However, data may be made available from the corresponding author upon reasonable request and with appropriate ethical justification.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors and co-authors of this study declare that they have no competing interests, including financial ties, sponsorships, or industry involvement.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that no funding was received for this study. All data were obtained from patient files with verbal consent, which was approved by the ethics committee.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eDr. Bashar A. Abdulhassan (Assistant Professor of General Surgery) supervised the study, oversaw the data collection process, and reviewed and critically revised the manuscript.\u003c/li\u003e\n \u003cli\u003eDr. Hasan Naeem Kareem (Lecturer) contributed to data collection and manuscript writing.\u003c/li\u003e\n \u003cli\u003eDr. Salim K. Hajwal (Lecturer) contributed to data collection and manuscript writing.\u003c/li\u003e\n \u003cli\u003eDr. Osama N. Htitani (M.B.Ch.B) contributed to data collection, protocol development and manuscript writing.\u003c/li\u003e\n \u003cli\u003eDr. Jaafar Bashar Abass (M.B.Ch.B) contributed to data collection and manuscript writing.\u003c/li\u003e\n \u003cli\u003eDr. Abdulillh R. Khamess (Medical Student) contributed to study conception and design, data collection, data analysis and statistics, and manuscript writing.\u003c/li\u003e\n \u003cli\u003eDr. Ahmed K. Elishehaby (Medical Student) contributed to data collection, protocol development and manuscript writing.\u003c/li\u003e\n \u003cli\u003eDr. Hassan H. ElAdl (Medical Student) contributed to data collection, protocol development and manuscript writing.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank the College of Medicine, Al-Nahrain University, for supporting this study. Special thanks to Prof. Dr. Anees Khalil Nayel, Dean of the College of Medicine, Al-Nahrain University, and all the nursing staff, medical personnel, and technical staff at the Trauma Center of Al-Nahrain Teaching Hospital for their valuable assistance.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003e\u003cstrong\u003eWorld Health Organization. Injury and violence: the facts. 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\u003cstrong\u003e59\u003c/strong\u003e(5).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Revised Trauma Score (RTS), MGAP Score, mortality prediction, multiple trauma patients, in-hospital mortality, ICU admission, low-resource settings","lastPublishedDoi":"10.21203/rs.3.rs-6597313/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6597313/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eTrauma holds up a significant global health burden, particularly in countries like Iraq, which are classified as low and middle-income (LMICs), where the situation is worsened by conflicts, road traffic accidents, as well as inadequate resources for healthcare. Despite the widely accepted role of trauma scoring systems like the Revised Trauma Score (RTS) and the Mechanism, Glasgow Coma Scale, Age, and Arterial Pressure (MGAP) Score in high-income countries, very little has been done to explore their predictive accuracy in low-resource settings. This study will address this gap by assessing and contrasting RTS and MGAP in their ability to predict mortality in Iraqi trauma patients.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA prospective observational study will be conducted at Al-Kadhimiya Teaching Hospital, Baghdad, from March to November 2025. Consecutive patients aged\u0026thinsp;\u0026ge;\u0026thinsp;16 years with multiple traumas (injuries\u0026thinsp;\u0026ge;\u0026thinsp;2 body regions) presenting within six hours of injury will be enrolled. Exclusions include transfers, pre-evaluation deaths, burns, and pregnancy. Data collection comprises two phases: initial assessment of physiological parameters (GCS, systolic blood pressure, respiratory rate) and injury mechanisms in the emergency department, followed by daily follow-ups in surgical wards/ICU until discharge or death. Primary outcomes include in-hospital mortality, while secondary outcomes assess ICU admission and surgical intervention. Predictive accuracy will be evaluated using the area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, and predictive values via IBM SPSS Statistics.\u003c/p\u003e\u003ch2\u003eDiscussion\u003c/h2\u003e \u003cp\u003eThis study fills the critical gap of evaluating RTS and MGAP under resource-constrained conditions in Iraq, where prehospital time delays and poor capacity in the ICU are negative factors that influence trauma outcomes. This will lead to better triage protocols for directing patients toward high-risk categories while utilizing resources effectively in an overcrowded ED. Single-center design and variability in clinical expertise limit this study. Future research should be expanded to multicenter cohorts and long-term outcomes. Refined trauma care strategies will thus reduce avoidable deaths through the contextualization of global evidence relating to the challenges that confront Iraq.\u003c/p\u003e\u003ch2\u003eTrial Registration:\u003c/h2\u003e \u003cp\u003eRegistered prospectively at ClinicalTrials.gov (ID: NCT06744985) and approved by the Institutional Review Board of Al-Nahrain University College of Medicine (ID: UNCOMIRB20250382).\u003c/p\u003e","manuscriptTitle":"Comparative Evaluation of the Revised Trauma Score and MGAP Score for Mortality Prediction in Multiple Trauma Patients: Protocol for a Prospective Observational Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-16 13:12:51","doi":"10.21203/rs.3.rs-6597313/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fd2f0c10-7f07-4826-97a4-4b0f4c433151","owner":[],"postedDate":"May 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-05-27T15:08:10+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-16 13:12:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6597313","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6597313","identity":"rs-6597313","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}