Journal of Emergency Practice and Trauma

The Prototype Scoring System in Predicting Probability of Survival for Multiple Trauma Patients in Indonesia

Document Type : Original Article

Authors

Willy Johan 1
Ari Prasetyadjati 2
Istan Irmansyah Irsan 2
Munsifah Zaiyanah 2
Nanik Setijowati 3

1 Department of Emergency Medicine, Faculty of Medicine, Universitas Brawijaya, Saiful Anwar General Hospital, Malang – Indonesia

2 Department of Emergency Medicine, Faculty of Medicine, Universitas Brawijaya, Saiful Anwar General Hospital, Malang – Indonesia

3 Department of Public Health, Faculty of Medicine, Universitas Brawijaya, Malang - Indonesia

https://doi.org/Doi:10.34172/jept.2025.18
Abstract
Objective: Trauma-related deaths are among the top 10 causes of mortality, with an average of
three deaths from traffic accidents every hour in Indonesia. In 2012, there were 117,949 traffic
accidents resulting in 29,544 deaths (25.04%). In 2021, there were 103,645 accidents with 25,266
deaths (24.37%). Despite efforts to record trauma cases in Indonesia, existing scoring systems from
developed countries face limitations. This study aims to propose a new, locally adapted scoring
system to improve the management of multiple trauma cases, particularly at Saiful Anwar General
Hospital (RSSA), Malang.
Methods: This observational analytic study with a retrospective cohort design was conducted at
RSSA, Malang, Indonesia, from January 2021 to December 2022. A total of 506 multiple trauma
patients from the RSSA Emergency Department were included, selected through purposive
sampling. Data analysis involved the use of the t-test or the Mann-Whitney U test for numerical
and ordinal data, the chi-square or Fisher’s test for nominal data, followed by multivariate logistic
regression to establish a scoring system.
Results: Logistic regression through backward elimination identified 15 significant predictors of
in-hospital mortality: age (P=0.000, OR=0.967), pulse rate (P=0.006, OR=0.981), GCS (P=0.000,
OR=1.381), intracerebral hemorrhage (P=0.105, OR=0.966), subdural hemorrhage (P=0.001,
OR=0.875), infratentorial hemorrhage (P=0.000, OR=0.151), subfalcine herniation (P=0.038,
OR=0.871), transtentorial herniation (P=0.050, OR=0.038), mandibular fracture (P=0.004,
OR=0.235), etc. GCS was the strongest predictor (Wald=50.54). Although intracerebral hemorrhage
and lung tissue injury (P>0.05) were retained due to clinical relevance, the model showed excellent
discriminatory power, with an area under the curve (AUC-ROC) of 0.917 and a 95% confidence
interval of 0.886–0.948.
Conclusion: The MTPS scoring system developed in this study can predict the prognosis of multiple
trauma patients with strong discrimination (0.917) and is expected to improve the quality of trauma
care in accordance with WHO guidelines at RSSA Malang.

Keywords

Hospital mortality
Logistic models
Multiple trauma
Retrospective studies
Scoring systems
Subjects
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Journal of Emergency Practice and Trauma
Volume 10, Issue 2
July 2024
Pages 128-136

  • Receive Date 01 October 2025
  • Revise Date 19 October 2025
  • Accept Date 20 October 2025

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