Comparative Performance of Revised Trauma Score, Injury Severity Score and Penetrating Abdominal Trauma Index for Predicting Mortality Following Penetrating Abdominal Trauma: A Prospective Cohort Study

Abstract Background: Penetrating abdominal trauma (PAT) is associated with significant morbidity and mortality, particularly in resource-constrained trauma settings like. In developing countries. Several trauma scoring systems are used to predict outcomes; however, comparative data from South Asia remain limited. This study evaluated the predictive performance of RTS, ISS, and PATI for mortality and morbidity in patients with penetrating abdominal trauma and explored the association between body mass index (BMI) and clinical outcomes. Methods: It was a prospective observational study conducted over 18 months at a tertiary trauma center in New Delhi, India. After Institutional ethical clearance obtained 73 adult patients with penetrating abdominal trauma were included. Data required for study collected with a standard Performa. Trauma scores calculated. The primary outcome was 30-day mortality. Secondary outcomes included postoperative complications, ICU admission, and hospital length of stay. Predictive performance was assessed using receiver operating characteristic (ROC) curve analysis. Results: The cohort had a median age of 25 years, and 91.8% were male. Overall mortality was 6.8%, while postoperative complications occurred in 50.7% of patients. RTS demonstrated the highest predictive accuracy for mortality (AUROC 0.982; 95% CI 0.951–1.00; p < 0.001), followed by ISS (AUROC 0.863; p = 0.007) and PATI (AUROC 0.771; p = 0.043). At optimal cut-offs (7.55), RTS achieved 100% sensitivity and 90% specificity. Higher ISS and PATI scores were significantly associated with ICU admission, while increasing PATI scores correlated with greater complication severity and mortality. Lower RTS values were associated with adverse outcomes including ICU admission, ARDS, renal failure, surgical site infection, and mortality. BMI showed no significant association with mortality, complications, ICU admission, or hospital stay. Conclusion: RTS demonstrated superior performance for predicting mortality in penetrating abdominal trauma and may be the most useful triage tool in resource-limited settings. ISS and PATI provided valuable information regarding injury severity and postoperative morbidity. PATI served well to predict post-operative complications in our study. BMI was not a significant predictor of outcomes in this cohort. Larger multicenter studies are required to validate these findings.