Predicting mortality in adult trauma patients : MGAP compared to T-RTS

Abstract

Background: The standard for pre-hospital triage scores is the Triage revised trauma score (T-RTS). However, it can be considered too complicated to use in the pre-hospital setting and includes variables such as respiration rate. It is not as reliable as it is affected by other factors including mechanical ventilation, mechanism of injury, and age. The Mechanism, Glasgow coma scale, age, arterial pressure (MGAP), is a triage model that includes mechanisms of injury and age and eliminates respiration rate. This dissertation seeks to find out whether MGAP is better predictor of mortality than T-RTS. Research Question: Which triage tool is more effective in predicting mortality among adult trauma patients: MGAP compared to T-RTS? PICO Elements: The population that was studied for the purpose of this dissertation includes adults that suffered from trauma. The intervention was Mechanism, Glasgow coma scale, age, arterial pressure (MGAP) and it was compared to triage revised trauma score (T-RTS). The outcome was the ability to predict mortality. Method: Through the PICO elements, keywords were generated which were pooled using search tools including Boolean operators, truncations, and wild cards. Then limiters where added and searches were conducted in the thirteen databases chosen among which were PubMed, Scopus, and EBSCO. Additionally, inclusion and exclusion criteria were applied to further eliminate articles not relevant to the research question. Articles included where those that focused on the adult population and articles that were in written in English. While excluded articles where those that focused on the paediatric population and articles not written in English. This search is demonstrated through a PRISMA flow diagram (2020). CASP tools and the JBI checklist were used to aid the author in assessing the validity and reliability of the evidence produced from these studies. Results: Seven key studies were identified including one systematic review and six cohort studies. Out of which four studies concluded that MGAP was a better predictor of mortality when compared to T-RTS. Conclusion: A definite conclusion could not be determined due to weaknesses in the methodologies of the studies and due to lack of consistency among outcomes between the studies. Thus, further research is needed to answer the research question. Implications and Recommendations: Recommendations for practice include conducting more studies that are based on nurse-led triage and which assess patients suffering from all levels of trauma. A recommendation for further practice would be that triage scores should be used along with experience to guide decision making. Recommendation for education includes more training exercises for mass casualty situations. A suggestion for management, then, would be to provide further training and educational material.