TRAUMA: EARLY PREDICTORS OF MORTALITY IN POLYTRAUMA PATIENTS PRESENTING TO THE ER

Abstract

Background: Early detection of polytrauma patients at high risk of death is critical for prompt resuscitation, triage, monitoring, and escalation of trauma care. However, the predictive usefulness of different clinical factors and trauma grading systems differs by population and clinical situation.

Objective: This systematic study looked at early demographic, neurological, physiological, hemodynamic, laboratory, injury-related, and comorbidity determinants of mortality in polytrauma patients who presented to the emergency department.

Methods: We performed a systematic literature review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. MEDLINE/PubMed, Scopus, and Web of Science were searched for terms relating to polytrauma, emergency care, mortality, prognostic variables, and trauma prediction models. Adult patients with polytrauma or serious trauma were eligible for the research, which looked at predictors accessible during the initial or early emergency assessment. Because of significant methodological and clinical variation, data on patient characteristics, predictors, mortality outcomes, and prognostic performance were collected and analysed narratively.

Results: A total of 4,942 records were identified, and 14 studies were assessed as eligible for inclusion. Increasing age, particularly ≥69 years, female sex, coronary heart disease, and cardiopulmonary resuscitation, was associated with increased mortality. Neurological status was a consistent predictor, with GCS ≤11 significantly associated with increased mortality. Systolic blood pressure, hypotension, heart rate, and respiratory rate were important physiological predictors. The Shock Index showed variable discriminatory performance according to the timing of assessment, with AUC values of approximately 0.55 overall, 0.59 prehospital, and 0.64 during hospital assessment. Laboratory markers, including lactate, pH, and base excess, provided complementary prognostic information, although evidence for lactate was inconsistent. Among the prediction models, the PMPS demonstrated the strongest discrimination (AUC 93.4%), followed by the APACHE II (84.6%), REMS (80.8%), and RTS (77.4%), whereas the ISS and Shock Index showed comparatively lower discrimination (69.7%).

Conclusion: Early mortality in polytrauma is multifaceted and should be assessed using an integrated set of demographic, neurological, physiological, and injury-related characteristics rather than a single predictor. GCS, systolic blood pressure, age, and hemodynamic state are excellent early indications. Multivariable models, particularly PMPS and MGAP, outperformed individual indices in terms of discriminatory performance and may be useful for early risk classification, triage, and treatment escalation. Additional external validation in varied trauma populations is needed.