Comparative Predictive Accuracy of EMTRAS, REMS, and GAP Scores for Mortality, Endotracheal Intubation, and Length of Hospitalization in Trauma Patients: The First Prospective Cohort Study From Iraq

Trauma continues to pose a major global public health challenge, accounting for millions of deaths and disabilities each year, with low and middle income countries bearing a disproportionately high burden . Studies suggest that injuries will rise further among the leading causes of mortality, with road traffic accidents, falls, and suicide being among the most prevalent contributors. Approximately 90 percent of trauma deaths occur in low and middle income settings, and a significant portion of these fatalities are considered preventable with the appropriate care.

Efficient risk stratification plays an important role in managing trauma patients, particularly in emergency settings where delays in treatment can have fatal outcomes. Early identification of severely injured individuals supports timely referral and initiation of interventions, both of which are consistently associated with reduced morbidity and mortality.

A wide range of trauma scoring systems have been developed to estimate injury severity, guide triage decisions, and predict outcomes. Yet many established scores, such as the Injury Severity Score and the Trauma and Injury Severity Score, depend on detailed anatomical information that is often unavailable during the critical early phase of emergency care. Others, such as the Revised Trauma Score, are based on physiological indicators but are more complex and may not fully incorporate factors like age or specific injury types. Similarly, scoring systems such as the Acute Physiology and Chronic Health Evaluation II rely on laboratory values, making them less suitable for rapid use in emergency departments.

This limitation becomes even more evident in low and middle income countries, where resource constraints, limited access to complete medical records, and varying trauma patterns make it difficult to apply many existing scoring tools. The need for simple, reliable, and rapid assessment tools that can be applied at the point of care in these environments is especially urgent.

This study focuses on three trauma scores that can be applied early in a patient's clinical course and require only minimal resources: the Emergency Trauma Score, the Rapid Emergency Medicine Score, and the Glasgow Coma Scale Age Pressure score.