Accuracy and External Validation of mREMS in Road Traffic Injuries

Recruiting

• Conditions: Trauma

• Registration Number: NCT06740409
• Lead Sponsor: Al-Nahrain University

Brief Summary

The goal of this prospective observational study is to assess the accuracy and external validation of the Modified Rapid Emergency Medicine Score (mREMS) in predicting outcomes for patients with road traffic injuries (RTIs) admitted to the emergency department of a hospital in Baghdad.

The main questions it aims to answer are:

How accurate is the mREMS in predicting the prognosis of road traffic injury patients? Does the mREMS provide reliable predictive value in a local context, specifically in Baghdad?

Participants will:

Be assessed using the mREMS upon admission to the emergency department. Have their clinical outcomes, including mortality, need for surgery, and length of stay, monitored throughout their hospital stay.

Detailed Description

Road traffic injuries (RTIs) are one of the leading causes of morbidity and mortality globally, disproportionately affecting low- and middle-income countries such as Iraq. Accurate and standardized clinical tools are essential for triaging patients and improving clinical outcomes in resource-limited emergency departments. Emergency departments play a central role in the timely assessment and management of RTI patients. The Modified Rapid Emergency Medicine Score (MREMS) has emerged as a valuable tool for predicting in-hospital mortality and other critical outcomes in emergency settings. The Modified Rapid Emergency Medicine Score (mREMS) evaluates key physiological parameters, including age, heart rate, respiratory rate, oxygen saturation, mean arterial pressure, and the Glasgow Coma Scale (GCS), to provide a rapid and standardized assessment of injury severity.

Validation studies in Thailand and other regions have demonstrated mREMS's reliability in predicting in-hospital mortality and critical care needs. These studies have used performance metrics such as sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) to assess the tool's predictive accuracy. Despite these advancements, there remains a lack of validation studies in Iraq, where healthcare systems face unique challenges, including poor road safety and under-resourced emergency departments.

Previous studies emphasize the importance of adapting and validating scoring systems for specific populations. In Baghdad, RTIs are a significant public health burden, but no standardized tools like mREMS have been validated in this context. This study aims to address this gap by evaluating mREMS's performance in predicting mortality, morbidity, ICU admission, and length of hospital stay requirements in RTI patients in a Baghdad hospital. The findings will contribute to improving trauma care and inform the adaptation of standardized scoring systems in Iraq.

Study Timeline

• Study First Submitted: 2024-12-14
• Study First Submitted QC: 2024-12-14
• Study First Posted: 2024-12-18
• Study Start: 2024-12-20
• Status Verified: 2025-04
• Last Update Submitted: 2025-04-13
• Last Update Posted: 2025-04-16
• Primary Completion: 2025-05-01
• Study Completion: 2025-05-15

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 180

Inclusion Criteria

• Patients with road traffic injuries (RTIs) admitted to the emergency department.
• Written informed consent provided by the patient or a legal representative (if the patient is unconscious or unable to provide consent).
• Patients presenting to the emergency department within 4 hours of the injury.
• Availability of complete physiological data for MREMS calculation.
• Patients whose clinical outcomes (e.g., mortality, length of hospital stay, need for intensive care) are available for follow-up and analysis.

Exclusion Criteria

• Patients with injuries not related to road traffic accidents (e.g., falls, burns, or violence-related injuries).
• Pregnant women, due to the potential risk involved in the study and unique considerations in trauma care.
• Patients with pre-existing severe chronic conditions (e.g., end-stage renal disease, terminal cancer) that could severely affect outcomes.
• Patients who are unable or unwilling to provide informed consent.
• Patients who were transferred from another hospital.
• Incomplete or missing data for mREMS parameters.
• Patients who leave against medical advice (LAMA) or are discharged before outcome data can be collected.

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
In hospital mortality	In-Hospital Phase (average of 7 days through discharge); Post-Discharge Follow-Up: Day 7, Day 30	Mortality (death) during hospitalization.
Accuracy Assessment of the modified Rapid Emergency Medicine Score (mREMS)	the first 4 hours after ER admission	range from 0 to 26. A higher mREMS score indicates a greater risk of mortality.

Secondary Outcome Measures

Name	Time	Method
Length of Hospitalization	Up to discharge, an average of 7 days	The total duration of a patient's stay in the hospital, measured from the date of admission to the date of discharge. This includes all days spent in general wards, intensive care units (ICU), and other hospital departments as part of their treatment course.
Need for ICU Admission	Up to discharge, an average of 7 days	The requirement for admission to the intensive care unit (ICU) is determined by the presence of severe clinical deterioration, significant complications, or the need for advanced monitoring and life-support measures.

Trial Locations

Locations (1)

College of Medicine - Al-Nahrain University; 🇮🇶 Baghdad, Iraq