Comparative Analysis of MGAP and GAP Trauma Scores in Predicting Outcomes for Multiple Trauma Patients

NCT ID: NCT06732791

Last Updated: 2025-05-28

Basic Information

• Recruitment Status: RECRUITING
• Total Enrollment: 522 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2025-01-20
• Study Completion Date: 2025-11-20

Brief Summary

The goal of this prospective cohort study is to compare the predictive accuracy of the MGAP and GAP trauma scores in determining the prognosis of multiple trauma patients admitted to the emergency department at Al-Kadhimiya Teaching Hospital, Iraq.

The main questions it aims to answer are:

Does the MGAP score provide a more accurate prediction of outcomes compared to the GAP score? Are there specific subgroups of trauma patients where one score demonstrates superior predictive utility over the other?

Participants will:

Be assessed using both the MGAP and GAP scores upon admission to the emergency department.

Have their clinical outcomes, including mortality, length of stay, and need for surgery, tracked throughout their hospital stay.

Detailed Description

Lower-middle income countries (LMICs) pay the price of a growing volume of trauma, as collateral damage for development, rapid urbanization and sociodemographic transition. Trauma includes various types of injuries, which can be either penetrating or non-penetrating, typically categorized as unintentional (like those from road accidents, falls, drownings, and burns) or intentional (including self-inflicted harm and violence). According to the WHO Global Burden of Disease project, around one billion individuals require trauma-related healthcare each year, accounting for 12% of the total global disease burden. Trauma represents a significant global health challenge, causing more fatalities than HIV/AIDS, tuberculosis, malaria, and maternal mortality combined, with over five million deaths annually attributed to traumatic injuries. This makes trauma the fourth leading cause of death worldwide, and the WHO predicts a 40% increase in trauma-related fatalities by 2030, with nearly 90% of these deaths occurring in low and middle-income countries. Most trauma-related deaths happen shortly after the injury occurs, predominantly during the pre-hospital phase, which requires emergency service providers to quickly evaluate the patient's condition and the severity of the trauma to ensure proper referrals.

Research indicates that between 25% and 50% of trauma-related deaths are preventable. The mortality rate serves as the most reliable indicator of trauma prognosis, which can be assessed in two time frames: short-term (within 24 hours) and long-term (over four weeks). An efficient scoring system for trauma patients can assist physicians in rapidly and accurately evaluating injury severity and determining patient management. Timely intervention is crucial in trauma care, as providing swift and suitable treatment has been proven to reduce both mortality and morbidity rates consistently. Such prompt care depends on effective risk stratification in emergency settings. Currently, there are several trauma scoring systems available, each with differing accuracy and reliability for assessing morbidity and mortality risks in patients. Among these are the MGAP and GAP scores, which are simplified, physiologically-based scoring systems not yet widely implemented in low- and middle-income countries. The MGAP acronym stands for "mechanism of injury, GCS, age, and systolic blood pressure," and this score was initially developed in France as a pre-hospital triage tool to predict 30-day mortality. It has also been validated as effective in predicting prolonged ICU stays and major hemorrhages within a European demographic. The MGAP score has been adapted into the GAP score, which omits the injury mechanism for ease of use in clinical environments. GAP stands for "GCS, age, and systolic blood pressure," and it has been validated using data from the Japan Trauma Data Bank. Sartorius et al. determined in their research that the MGAP score can effectively predict the mortality rate of hospitalized trauma patients. Similarly, Yutaka Kondo et al. found that the GAP score can reliably predict the mortality rate of trauma patients in a hospital setting.

Despite advancements in trauma care, predicting outcomes for multiple trauma patients remains a critical challenge in clinical settings, particularly in low-resource environments like Iraq. There is a concerning scarcity of studies within the Iraqi context that evaluate the validity and reliability of scoring systems tailored to the region's unique demographic and healthcare landscape. This underscores the urgent need for comprehensive research to assess the efficacy of the MGAP and GAP Trauma Scores in predicting outcomes for multiple trauma patients in Iraq. Therefore, this study aims to evaluate the effectiveness, reliability, and accuracy of the MGAP and GAP Trauma Scores in assessing the severity of injuries and predicting outcomes for a diverse population of multiple trauma patients.

Conditions

Trauma

Study Design

• Observational Model Type: COHORT
• Study Time Perspective: PROSPECTIVE

Eligibility Criteria

Inclusion Criteria

• Aged 16 years or older.
• Patients presenting with multiple trauma (Multiple trauma is defined as injuries involving two or more body regions or organ systems that might need coordinated multidisciplinary management).
• Patients presenting to the emergency department within 6 hours of sustaining trauma.
• Patients or their legal representatives must provide informed consent for participation in the study.

Exclusion Criteria

• Transfers from other facilities with interventions that may affect GAP or MGAP reliability.
• Pregnant women.
• Burn injuries represent the primary mechanism of trauma.
• Incomplete records or failure of follow-up
• Patients who are deceased upon arrival at the emergency department.
• Patient discharge against medical advice.

• Minimum Eligible Age: 16 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Al-Nahrain University

OTHER

Sponsor Role: lead

Responsible Party

Abdul-Ilah R. Khamis

Principal Investigator

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Mohammad A. Hamdawi, Lecturer of general surgery

Role: STUDY_DIRECTOR

College Of Medicine - Nahrain University

Locations

College of Medicine - Al-Nahrain University

Baghdad, , Iraq

Site Status: RECRUITING

Countries

Iraq

Central Contacts

Abdulillah R. Khamees

Role: CONTACT

allaabed987@ced.nahrainuniv.edu.iq

+9647838571013

Facility Contacts

Mohammad A. Hamdawi, Lecturer of general surgery

Role: primary

mohammedhamdawi@nahrainuniv.edu.iq

009647801604775

References

Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med. 2006 Nov;3(11):e442. doi: 10.1371/journal.pmed.0030442.

Reference Type: BACKGROUND

PMID: 17132052 (View on PubMed)

Kondo Y, Abe T, Kohshi K, Tokuda Y, Cook EF, Kukita I. Revised trauma scoring system to predict in-hospital mortality in the emergency department: Glasgow Coma Scale, Age, and Systolic Blood Pressure score. Crit Care. 2011 Aug 10;15(4):R191. doi: 10.1186/cc10348.

Reference Type: RESULT

PMID: 21831280 (View on PubMed)

Raux M, Sartorius D, Le Manach Y, David JS, Riou B, Vivien B. What do prehospital trauma scores predict besides mortality? J Trauma. 2011 Sep;71(3):754-9. doi: 10.1097/TA.0b013e3181fd0dae.

Reference Type: RESULT

PMID: 21336194 (View on PubMed)

Sartorius D, Le Manach Y, David JS, Rancurel E, Smail N, Thicoipe M, Wiel E, Ricard-Hibon A, Berthier F, Gueugniaud PY, Riou B. 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 Mar;38(3):831-7. doi: 10.1097/CCM.0b013e3181cc4a67.

Reference Type: RESULT

PMID: 20068467 (View on PubMed)

Orhon R, Eren SH, Karadayi S, Korkmaz I, Coskun A, Eren M, Katrancioglu N. Comparison of trauma scores for predicting mortality and morbidity on trauma patients. Ulus Travma Acil Cerrahi Derg. 2014 Jul;20(4):258-64. doi: 10.5505/tjtes.2014.22725.

Reference Type: RESULT

PMID: 25135020 (View on PubMed)

Nirula R, Maier R, Moore E, Sperry J, Gentilello L. Scoop and run to the trauma center or stay and play at the local hospital: hospital transfer's effect on mortality. J Trauma. 2010 Sep;69(3):595-9; discussion 599-601. doi: 10.1097/TA.0b013e3181ee6e32.

Reference Type: RESULT

PMID: 20838131 (View on PubMed)

Shoko T, Shiraishi A, Kaji M, Otomo Y. Effect of pre-existing medical conditions on in-hospital mortality: analysis of 20,257 trauma patients in Japan. J Am Coll Surg. 2010 Sep;211(3):338-46. doi: 10.1016/j.jamcollsurg.2010.04.010. Epub 2010 Jul 13.

Reference Type: RESULT

PMID: 20800190 (View on PubMed)

Rehn M, Perel P, Blackhall K, Lossius HM. Prognostic models for the early care of trauma patients: a systematic review. Scand J Trauma Resusc Emerg Med. 2011 Mar 20;19:17. doi: 10.1186/1757-7241-19-17.

Reference Type: RESULT

PMID: 21418599 (View on PubMed)

MacKenzie EJ, Rivara FP, Jurkovich GJ, Nathens AB, Frey KP, Egleston BL, Salkever DS, Scharfstein DO. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med. 2006 Jan 26;354(4):366-78. doi: 10.1056/NEJMsa052049.

Reference Type: RESULT

PMID: 16436768 (View on PubMed)

GBD 2016 Causes of Death Collaborators. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017 Sep 16;390(10100):1151-1210. doi: 10.1016/S0140-6736(17)32152-9.

Reference Type: RESULT

PMID: 28919116 (View on PubMed)

GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015 Jan 10;385(9963):117-71. doi: 10.1016/S0140-6736(14)61682-2. Epub 2014 Dec 18.

Reference Type: RESULT

PMID: 25530442 (View on PubMed)

Gerdin M, Roy N, Khajanchi M, Kumar V, Fellander-Tsai L, Petzold M, Tomson G, von Schreeb J; Towards Improved Trauma Care Outcomes in India (TITCO). Validation of a novel prediction model for early mortality in adult trauma patients in three public university hospitals in urban India. BMC Emerg Med. 2016 Feb 22;16:15. doi: 10.1186/s12873-016-0079-0.

Reference Type: RESULT

PMID: 26905408 (View on PubMed)

Haagsma JA, Graetz N, Bolliger I, Naghavi M, Higashi H, Mullany EC, Abera SF, Abraham JP, Adofo K, Alsharif U, Ameh EA, Ammar W, Antonio CA, Barrero LH, Bekele T, Bose D, Brazinova A, Catala-Lopez F, Dandona L, Dandona R, Dargan PI, De Leo D, Degenhardt L, Derrett S, Dharmaratne SD, Driscoll TR, Duan L, Petrovich Ermakov S, Farzadfar F, Feigin VL, Franklin RC, Gabbe B, Gosselin RA, Hafezi-Nejad N, Hamadeh RR, Hijar M, Hu G, Jayaraman SP, Jiang G, Khader YS, Khan EA, Krishnaswami S, Kulkarni C, Lecky FE, Leung R, Lunevicius R, Lyons RA, Majdan M, Mason-Jones AJ, Matzopoulos R, Meaney PA, Mekonnen W, Miller TR, Mock CN, Norman RE, Orozco R, Polinder S, Pourmalek F, Rahimi-Movaghar V, Refaat A, Rojas-Rueda D, Roy N, Schwebel DC, Shaheen A, Shahraz S, Skirbekk V, Soreide K, Soshnikov S, Stein DJ, Sykes BL, Tabb KM, Temesgen AM, Tenkorang EY, Theadom AM, Tran BX, Vasankari TJ, Vavilala MS, Vlassov VV, Woldeyohannes SM, Yip P, Yonemoto N, Younis MZ, Yu C, Murray CJ, Vos T. The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease study 2013. Inj Prev. 2016 Feb;22(1):3-18. doi: 10.1136/injuryprev-2015-041616. Epub 2015 Dec 3.

Reference Type: RESULT

PMID: 26635210 (View on PubMed)

Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, Abraham J, Adair T, Aggarwal R, Ahn SY, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Barker-Collo S, Bartels DH, Bell ML, Benjamin EJ, Bennett D, Bhalla K, Bikbov B, Bin Abdulhak A, Birbeck G, Blyth F, Bolliger I, Boufous S, Bucello C, Burch M, Burney P, Carapetis J, Chen H, Chou D, Chugh SS, Coffeng LE, Colan SD, Colquhoun S, Colson KE, Condon J, Connor MD, Cooper LT, Corriere M, Cortinovis M, de Vaccaro KC, Couser W, Cowie BC, Criqui MH, Cross M, Dabhadkar KC, Dahodwala N, De Leo D, Degenhardt L, Delossantos A, Denenberg J, Des Jarlais DC, Dharmaratne SD, Dorsey ER, Driscoll T, Duber H, Ebel B, Erwin PJ, Espindola P, Ezzati M, Feigin V, Flaxman AD, Forouzanfar MH, Fowkes FG, Franklin R, Fransen M, Freeman MK, Gabriel SE, Gakidou E, Gaspari F, Gillum RF, Gonzalez-Medina D, Halasa YA, Haring D, Harrison JE, Havmoeller R, Hay RJ, Hoen B, Hotez PJ, Hoy D, Jacobsen KH, James SL, Jasrasaria R, Jayaraman S, Johns N, Karthikeyan G, Kassebaum N, Keren A, Khoo JP, Knowlton LM, Kobusingye O, Koranteng A, Krishnamurthi R, Lipnick M, Lipshultz SE, Ohno SL, Mabweijano J, MacIntyre MF, Mallinger L, March L, Marks GB, Marks R, Matsumori A, Matzopoulos R, Mayosi BM, McAnulty JH, McDermott MM, McGrath J, Mensah GA, Merriman TR, Michaud C, Miller M, Miller TR, Mock C, Mocumbi AO, Mokdad AA, Moran A, Mulholland K, Nair MN, Naldi L, Narayan KM, Nasseri K, Norman P, O'Donnell M, Omer SB, Ortblad K, Osborne R, Ozgediz D, Pahari B, Pandian JD, Rivero AP, Padilla RP, Perez-Ruiz F, Perico N, Phillips D, Pierce K, Pope CA 3rd, Porrini E, Pourmalek F, Raju M, Ranganathan D, Rehm JT, Rein DB, Remuzzi G, Rivara FP, Roberts T, De Leon FR, Rosenfeld LC, Rushton L, Sacco RL, Salomon JA, Sampson U, Sanman E, Schwebel DC, Segui-Gomez M, Shepard DS, Singh D, Singleton J, Sliwa K, Smith E, Steer A, Taylor JA, Thomas B, Tleyjeh IM, Towbin JA, Truelsen T, Undurraga EA, Venketasubramanian N, Vijayakumar L, Vos T, Wagner GR, Wang M, Wang W, Watt K, Weinstock MA, Weintraub R, Wilkinson JD, Woolf AD, Wulf S, Yeh PH, Yip P, Zabetian A, Zheng ZJ, Lopez AD, Murray CJ, AlMazroa MA, Memish ZA. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012 Dec 15;380(9859):2095-128. doi: 10.1016/S0140-6736(12)61728-0.

Reference Type: RESULT

PMID: 23245604 (View on PubMed)

WHO. World report on Preventing injuries and violence: an overview. Geneva: World Health Organization; 2022.

Reference Type: RESULT

Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015 Aug 22;386(9995):743-800. doi: 10.1016/S0140-6736(15)60692-4. Epub 2015 Jun 7.

Reference Type: RESULT

PMID: 26063472 (View on PubMed)

Other Identifiers

010

Identifier Type: REGISTRY

Identifier Source: secondary_id

UNCOMIRB20241210B

Identifier Type: -

Identifier Source: org_study_id