Comparison of EMTRAS, REMS, and GAP Scores in Trauma (TRAPS)

March 3, 2026 updated by: Abdulillah R. Khamees, Al-Nahrain University

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

The goal of this prospective multicenter cohort study is to evaluate and compare the predictive utility of the EMTRAS, REMS, and GAP scores in determining key outcomes among trauma patients admitted to participating hospitals in Iraq. The primary outcomes of interest include mortality, the need for endotracheal intubation, and length of hospitalization.

The main questions it aims to answer are:

How accurately do EMTRAS, REMS, and GAP scores predict mortality in trauma patients?

How effective are these scores in predicting the need for endotracheal intubation?

How well do these scores correlate with hospitalization duration in trauma patients?

Participants will:

Be assessed using EMTRAS, REMS, and GAP scores upon admission to the emergency department.

Have their clinical outcomes, including survival, intubation requirements, and length of hospital stay, monitored throughout their hospitalization.

Study Overview

Status

Recruiting

Conditions

Detailed Description

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.

The Emergency Trauma Score was developed to estimate the risk of mortality in adult trauma patients using four parameters: age, Glasgow Coma Scale, base excess, and prothrombin time. These values are typically available within 30 minutes of arrival in the emergency department, and this score does not depend on anatomical injury data, making it suitable for early prognostic assessment. The Rapid Emergency Medicine Score is a simplified version of the Acute Physiology and Chronic Health Evaluation II and includes the Glasgow Coma Scale, respiratory rate, oxygen saturation, mean arterial pressure, heart rate, and age. Although originally developed for patients with non-traumatic conditions this score has demonstrated promising predictive ability in trauma populations as well. A modified version of this score, known as the modified Rapid Emergency Medicine Score, was later created to optimize performance in trauma patients. This version adjusts the weight given to age and the Glasgow Coma Scale and replaces mean arterial pressure with systolic blood pressure. The Glasgow Coma Scale Age Pressure score is derived from the Mechanism Glasgow Coma Scale Age Pressure score by removing the mechanism of injury component. It focuses exclusively on physiological variables, specifically Glasgow Coma Scale, age, and systolic blood pressure. The score can be calculated quickly based on a patient's initial clinical status and vital signs, making it especially well-suited for use in settings with limited resources. Previous studies have shown that it has strong predictive ability for mortality.

Although these trauma scores have demonstrated potential, most validation studies have been conducted in high income countries or through single-center retrospective designs. To increase generalizability and relevance to diverse healthcare environments, there is a need for prospective multicenter research, particularly in settings with limited resources and infrastructure.

This current study presents a multicenter prospective cohort analysis from Iraq, a country facing a substantial burden of trauma and significant healthcare challenges. This research compares the accuracy of the Emergency Trauma Score, Rapid Emergency Medicine Score, and Glasgow Coma Scale Age Pressure score in predicting in-hospital mortality among adult trauma patients. The findings aim to offer evidence-based insights that could improve trauma triage and clinical decision-making in resource-constrained environments.

Study Type

Observational

Enrollment (Estimated)

188

Contacts and Locations

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

Study Contact

Study Locations

  • Iraq
      • Baghdad, Iraq, 10001
        • Recruiting
        • College of Medicine - Al-Nahrain University
        • Sub-Investigator:
          • Murtada M. Abbas, Student
        • Contact:
        • Contact:
        • Principal Investigator:
          • Abdulillah R. Khamees, MBBCH
        • Sub-Investigator:
          • Ghadeer Mohammed Abbas, Student
        • Sub-Investigator:
          • Eathar Aljubori, Student

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

  • Child
  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Sampling Method

Non-Probability Sample

Study Population

The study population will consist of adult trauma patients (≥16 years) admitted to the emergency departments of participating tertiary hospitals in Iraq. Eligible patients will include those with blunt or penetrating trauma who present within 12 hours of injury. Patients will be assessed using EMTRAS, REMS, and GAP scores at admission, with outcomes monitored until discharge or in-hospital death.

Description

Inclusion Criteria:

  • Patients presenting to the emergency department with trauma.
  • Patients or their legal guardians must provide informed consent to participate in the study.
  • Admission within 12 hours of injury.

Exclusion Criteria:

  • Patients with incomplete clinical data or those discharged before scoring can be performed.
  • Pregnant patients (due to specific physiological considerations not accounted for by the scoring system).
  • Patients who died before arrival or were declared dead on arrival.
  • Patients who refuse participation or for whom informed consent cannot be obtained.

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
Accuracy Assessment of EMTRAS, REMS, and GAP Scores in Predicting In-Hospital Mortality
Time Frame: From admission to hospital discharge or death, up to 30 days.
This outcome evaluates the ability of EMTRAS (range 0-12), REMS (range 0-26), and GAP (range 3-24) to predict in-hospital mortality among trauma patients. Higher EMTRAS and REMS scores, and lower GAP scores, are expected to correlate with increased mortality risk.
From admission to hospital discharge or death, up to 30 days.

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Accuracy Assessment of EMTRAS, REMS, and GAP Scores in Predicting the Need for Endotracheal Intubation
Time Frame: From emergency department admission to intubation, discharge, or in-hospital death (up to 30 days).
This outcome evaluates the predictive performance of EMTRAS (range 0-12), REMS (range 0-26), and GAP (range 3-24) in identifying trauma patients requiring endotracheal intubation during hospitalization. Higher EMTRAS and REMS scores, and lower GAP scores, are expected to be associated with an increased likelihood of intubation.
From emergency department admission to intubation, discharge, or in-hospital death (up to 30 days).
Accuracy Assessment of EMTRAS, REMS, and GAP Scores in Predicting Length of Hospitalization
Time Frame: From hospital admission to discharge, up to 30 days.
This outcome assesses the ability of EMTRAS (range 0-12), REMS (range 0-26), and GAP (range 3-24) to predict hospitalization duration. Patients with lower severity scores (low EMTRAS/REMS or high GAP) are expected to have shorter hospital stays, while those with higher severity scores are likely to require prolonged hospitalization.
From hospital admission to discharge, up to 30 days.
Accuracy Assessment of EMTRAS, REMS, and GAP Scores in Predicting In-Hospital Morbidity
Time Frame: From hospital admission to discharge or death, up to 30 days.
This outcome evaluates the incidence and types of complications (morbidity) experienced by trauma patients, as predicted by EMTRAS (0-12), REMS (0-26), and GAP (3-24) scores. Higher EMTRAS and REMS values, and lower GAP scores, are expected to correlate with increased morbidity, including respiratory complications, infections, prolonged mechanical ventilation, and other trauma-related adverse events.
From hospital admission to discharge or death, up to 30 days.

Collaborators and Investigators

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

Sponsor

Al-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)

September 15, 2025

Primary Completion (Estimated)

December 1, 2026

Study Completion (Estimated)

December 15, 2026

Study Registration Dates

First Submitted

September 16, 2025

First Submitted That Met QC Criteria

September 16, 2025

First Posted (Actual)

September 22, 2025

Study Record Updates

Last Update Posted (Actual)

March 4, 2026

Last Update Submitted That Met QC Criteria

March 3, 2026

Last Verified

March 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • UNCOMIRB2025934

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

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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