Physiological and anatomical index in reference to management of thoracic trauma

Abstract

Thoracic Trauma Index (TTI) is the method of quantifying the anatomical extent of the injury (proposed by Ivatury et al, 1987) which includes injuries to Intrathoracic organs only i.e., heart, major vessels, lungs and esophagus. We hare suggested the inclusion of injuries to thoracic boundaries I.e. chest wall and diaphragm in the overall anatomical assessment and have used the term Anatomical Index (AI). The extent of physiological abnormality induced by injury (Physiological Index-PI) was graded on a scale of increasing severity from 5–20 based on vital signs of patients on admission. Analysis of 352 patients with thoracic trauma (May, 1991-August, 1993) revealed that higher grades of PI is associated with higher mortality and morbidity. Values of AI have better correlation with PI than TTI. The AI values have also shown excellent correlation with survival. A composite prognostic score (PS) i.e. the sum of PI and AI has demonstrated a significant separation of survivors and nonsurvivors (p< 0.001). It is concluded that these anatomic indices and physiologic indices are useful in evaluating and prognosticating thoracic trauma.