Comparative Evaluation of the Revised Trauma Score and MGAP Score for Mortality Prediction in Multiple Trauma Patients: Protocol for a Prospective Observational Study

Background Trauma holds up a significant global health burden, particularly in countries like Iraq, which are classified as low and middle-income (LMICs), where the situation is worsened by conflicts, road traffic accidents, as well as inadequate resources for healthcare. Despite the widely accepted role of trauma scoring systems like the Revised Trauma Score (RTS) and the Mechanism, Glasgow Coma Scale, Age, and Arterial Pressure (MGAP) Score in high-income countries, very little has been done to explore their predictive accuracy in low-resource settings. This study will address this gap by assessing and contrasting RTS and MGAP in their ability to predict mortality in Iraqi trauma patients. Methods A prospective observational study will be conducted at Al-Kadhimiya Teaching Hospital, Baghdad, from March to November 2025. Consecutive patients aged ≥ 16 years with multiple traumas (injuries ≥ 2 body regions) presenting within six hours of injury will be enrolled. Exclusions include transfers, pre-evaluation deaths, burns, and pregnancy. Data collection comprises two phases: initial assessment of physiological parameters (GCS, systolic blood pressure, respiratory rate) and injury mechanisms in the emergency department, followed by daily follow-ups in surgical wards/ICU until discharge or death. Primary outcomes include in-hospital mortality, while secondary outcomes assess ICU admission and surgical intervention. Predictive accuracy will be evaluated using the area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, and predictive values via IBM SPSS Statistics. Discussion This study fills the critical gap of evaluating RTS and MGAP under resource-constrained conditions in Iraq, where prehospital time delays and poor capacity in the ICU are negative factors that influence trauma outcomes. This will lead to better triage protocols for directing patients toward high-risk categories while utilizing resources effectively in an overcrowded ED. Single-center design and variability in clinical expertise limit this study. Future research should be expanded to multicenter cohorts and long-term outcomes. Refined trauma care strategies will thus reduce avoidable deaths through the contextualization of global evidence relating to the challenges that confront Iraq. Trial Registration: Registered prospectively at ClinicalTrials.gov (ID: NCT06744985) and approved by the Institutional Review Board of Al-Nahrain University College of Medicine (ID: UNCOMIRB20250382).