INTRODUCTION: Our aim in this study was to assess whether the new Glasgow Coma 
Scale, Age, and Systolic Blood Pressure (GAP) scoring system, which is a 
modification of the Mechanism, Glasgow Coma Scale, Age, and Arterial Pressure 
(MGAP) scoring system, better predicts in-hospital mortality and can be applied 
more easily than previous trauma scores among trauma patients in the emergency 
department (ED).
METHODS: This multicenter, prospective, observational study was conducted to 
analyze readily available variables in the ED, which are associated with 
mortality rates among trauma patients. The data used in this study were derived 
from the Japan Trauma Data Bank (JTDB), which consists of 114 major emergency 
hospitals in Japan. A total of 35,732 trauma patients in the JTDB from 2004 to 
2009 who were 15 years of age or older were eligible for inclusion in the study. 
Of these patients, 27,154 (76%) with complete sets of important data (patient 
age, Glasgow Coma Scale (GCS) score, systolic blood pressure (SBP), respiratory 
rate and Injury Severity Score (ISS)) were included in our analysis. We 
calculated weight for the predictors of the GAP scores on the basis of the 
records of 13,463 trauma patients in a derivation data set determined by using 
logistic regression. Scores derived from four existing scoring systems (Revised 
Trauma Score, Triage Revised Trauma Score, Trauma and Injury Severity Score and 
MGAP score) were calibrated using logistic regression models that fit in the 
derivation set. The GAP scoring system was compared to the calibrated scoring 
systems with data from a total of 13,691 patients in a validation data set using 
c-statistics and reclassification tables with three defined risk groups based on 
a previous publication: low risk (mortality < 5%), intermediate risk, and high 
risk (mortality > 50%).
RESULTS: Calculated GAP scores involved GCS score (from three to fifteen 
points), patient age < 60 years (three points) and SBP (> 120 mmHg, six points; 
60 to 120 mmHg, four points). The c-statistics for the GAP scores (0.933 for 
long-term mortality and 0.965 for short-term mortality) were better than or 
comparable to the trauma scores calculated using other scales. Compared with 
existing instruments, our reclassification tables show that the GAP scoring 
system reclassified all patients except one in the correct direction. In most 
cases, the observed incidence of death in patients who were reclassified matched 
what would have been predicted by the GAP scoring system.
CONCLUSIONS: The GAP scoring system can predict in-hospital mortality more 
accurately than the previously developed trauma scoring systems.