Accuracy and External Validation of mREMS in Road Traffic Injuries (AVE-MREMS)

June 7, 2026 updated by: Abdulillah R. Khamees, Al-Nahrain University

Can the Modified Rapid Emergency Medicine Score (mREMS) Predict Trauma Patients' Outcomes in a Deteriorated Health System After Decades of Conflict?

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.

Study Overview

Status

Completed

Conditions

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 Type

Observational

Enrollment (Actual)

292

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Iraq
      • Baghdad, Iraq
        • College of Medicine - Al-Nahrain University

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Sampling Method

Non-Probability Sample

Study Population

The study population will consist of adult patients aged 18 years and older presenting with road traffic injuries (RTIs) to the emergency department of a hospital in Baghdad. These patients will include individuals involved in motor vehicle collisions, motorcycle accidents, pedestrian-related incidents, and other road traffic-related traumas. Participants will be recruited within 4 hours of their injury to ensure timely assessment using the Modified Rapid Emergency Medicine Score (mREMS). Patients with a wide range of injury severities, from minor injuries to life-threatening trauma, will be included to evaluate the score's predictive accuracy across diverse clinical scenarios. The population will be representative of the local demographic and traffic conditions in Baghdad, ensuring the external validation of the mREMS score in this specific context.

Description

Inclusion Criteria:

  • 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:

  • 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 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 Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

What is the study measuring?

Primary Outcome Measures

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

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Length of Hospitalization
Time Frame: 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.
Up to discharge, an average of 7 days
Need for ICU Admission
Time Frame: 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.
Up to discharge, an average of 7 days

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Al-Nahrain University

Investigators

  • Study Director: Bashar A Abdulhassan, Assistant professor of surgery, College Of Medicine - Nahrain University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

March 1, 2025

Primary Completion (Actual)

January 1, 2026

Study Completion (Actual)

January 15, 2026

Study Registration Dates

First Submitted

December 14, 2024

First Submitted That Met QC Criteria

December 14, 2024

First Posted (Actual)

December 18, 2024

Study Record Updates

Last Update Posted (Actual)

June 9, 2026

Last Update Submitted That Met QC Criteria

June 7, 2026

Last Verified

June 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • UNCOMIRB20241214A
  • 017 (Other Identifier: Nahrain Medical Research Collective (NMRC))

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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