Mortality prediction in firearm injuries: Comparative performance of GCS, GAP, RTS, and lactate/hematocrit ratio

Yaksi M. A., Eyler Y., Yesilaras M., Ocak N. Y., Idil H.

American Journal of Emergency Medicine, cilt.100, ss.25-29, 2026 (SCI-Expanded, Scopus)

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 100
  • Basım Tarihi: 2026
  • Doi Numarası: 10.1016/j.ajem.2025.11.005
  • Dergi Adı: American Journal of Emergency Medicine
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CINAHL, EMBASE, MEDLINE, Health Research Premium Collection (ProQuest)
  • Sayfa Sayıları: ss.25-29
  • Anahtar Kelimeler: Firearm injuries, GAP score, Glasgow coma scale, Lactate/hematocrit ratio, Mortality prediction, Revised trauma score, Trauma scoring systems
  • Sağlık Bilimleri Üniversitesi Adresli: Evet

Özet

Objective: To compare the predictive performance of Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), GAP score, and lactate-hematocrit ratio for in-hospital mortality in patients with firearm injuries. Methods: This retrospective cohort study included 204 patients with firearm injuries admitted to the emergency department between January 1, 2013, and December 31, 2022. Patients with missing lactate data (n = 285) or those who refused treatment (n = 43) were excluded. Receiver operating characteristic (ROC) analysis was used to compare Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), GAP score, and lactate-hematocrit ratio for predicting in-hospital mortality. Patients were categorized based on their GCS scores into GCS = 15 and GCS < 15. The predictive performance for mortality was analyzed separately for each group. Results: Among 204 patients, 25 (12.3 %) died. In the overall population, RTS (AUC = 0.953), GCS (AUC = 0.950), and GAP score (AUC = 0.946) exhibited excellent discriminative ability, and the lactate/hematocrit ratio (AUC = 0.780) exhibited good discriminative ability. But in the GCS = 15 subgroup, lactate-hematocrit ratio demonstrated superior predictive performance (AUC = 0.855) compared to the GAP score (AUC = 0.517) and the RTS score (AUC = 0.594). Conclusion: Our study demonstrates that while RTS, GCS, and GAP score remain powerful predictors overall, the lactate-hematocrit ratio emerges as the most reliable risk assessment tool, specifically in firearm injury patients with a GCS of 15.