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.