Thoracic Trauma Severity Score Research Articles

Evaluation of Thoracic Trauma Severity Score (TTSS) in Assessing and Predicting Severity of Chest Trauma

Introduction: Chest trauma, which is frequently caused by road traffic accidents (RTAs), is a major public health concern worldwide. The Thoracic Trauma Severity Score (TTSS) provides a standardized method for assessing the severity of chest injuries, which aids in treatment decisions and outcome prediction. Material and Methods: This observational study aimed to determine the effectiveness of the TTSS in predicting the outcomes of chest trauma patients. The study, which conducted from September 2019 to May 2021 at the Department of Emergency Medicine, Apollo BGS Hospital in Mysore, included 65 adult patients who presented with chest injuries. Data on demographics, injury types, clinical characteristics, and outcomes has been collected and analyzed. Results: The majority of patients (70.8%) were male, with a mean age of 46.1 years. Road traffic accidents accounted for 80% of injuries. Rib fractures (95.4%) and lung contusions (75.4%) were the most common thoracic injuries observed. Patients with higher TTSS had prolonged hospital and ICU stays and increased need for mechanical ventilation. Mortality rates increased with higher TTSS, with 6.2% overall mortality. Conclusion: The TTSS proved effective in predicting outcomes of chest trauma patients, with higher scores associated with poorer outcomes. The findings highlight the value of TTSS in guiding early assessment and management strategies for chest trauma, ultimately aiding in reducing morbidity and mortality.

A Prospective Observational Study on the Outcome Assessment of Conservative Management Versus Intercostal Drainage (ICD) in Blunt Chest Injury Patients With ≤3 Rib Fractures in a North Indian Tertiary Care Center.

Introduction Trauma is the third most common cause of death in all age groups. One out of four trauma patients die due to thoracic injury or its complications. Seventy percent of thoracic traumas are due to blunt injury. This indicates the importance of chest trauma among all traumas. Quick and precise assessment bears paramount importance in deciding life-saving and definitive management. Often, the initial management in blunt injury patients is based on subjective assessment by the attending clinician. A scoring system that provides early identification of the patients at the greatest risk for respiratory failure and more likely to require mechanical ventilation and require prolonged care, as well as those with a higher mortality risk, may allow the early institution of intervention to improve outcomes. Thoracic Trauma Severity Score (TTSS) poses to be a precise tool in directing the management modality to be employed. Methodology This was an observational study including 112 patients of age >12 years, with blunt chest injury, sustaining ≤3 ribfractures, and with a stable chest wall. The patients with penetrating injury, those with blunt chest injury having flail segment, patients in the pediatricage group (<12 years), or polytrauma patients were excluded from our study. Of the 112 patients, 56 had been managed by intercostal drainage (ICD), and the rest (56) had been managed conservatively. Result Road traffic accidents (RTA) were the most common mode of injury in both groups. The percentage of the patients with one, two, and three ribfractures was57.14%, 32.14%, and 10.71%, respectively, in the ICD groupand 85.71%, 7.14%, and 7.14%, respectively, in the conservative management group (p = 0.124). The mean TTSS score was significantly more in the ICD group as compared to the conservative management group in the single rib fracture patients (p = 0.001*), as well as all patients of any number of rib fractures (p < 0.01*) (significance was defined as a value of p less than 0.05 {indicated by an asterisk}). The mean hospital stay was significantly lower in the conservative group as compared to the ICD group (p < 0.01*). The mean SF-36 (outcome) was significantly more in the conservative management group as compared to the ICD group (p = 0.020*). The mean cost of treatment was significantly more in the ICD groupas compared to the conservative management group (p < 0.001*). Conclusion In our study, a TTSS (as measured by the primary care surgeon) of >7, across any number of rib fractures, was preferably predictive of management by ICD, while a <7 value was favorable for conservative management. TTSS can be used as an important tool to predict the management modality in blunt chest injury patients with ≤3 ribfractures.

Early non-invasive ventilation and high-flow nasal oxygen therapy for preventing endotracheal intubation in hypoxemic blunt chest trauma patients: the OptiTHO randomized trial

BackgroundThe benefit–risk ratio of prophylactic non-invasive ventilation (NIV) and high-flow nasal oxygen therapy (HFNC-O2) during the early stage of blunt chest trauma remains controversial because of limited data. The main objective of this study was to compare the rate of endotracheal intubation between two NIV strategies in high-risk blunt chest trauma patients.MethodsThe OptiTHO trial was a randomized, open-label, multicenter trial over a two-year period. Every adult patients admitted in intensive care unit within 48 h after a high-risk blunt chest trauma (Thoracic Trauma Severity Score ≥ 8), an estimated PaO2/FiO2 ratio < 300 and no evidence of acute respiratory failure were eligible for study enrollment (Clinical Trial Registration: NCT03943914). The primary objective was to compare the rate of endotracheal intubation for delayed respiratory failure between two NIV strategies: i) a prompt association of HFNC-O2 and “early” NIV in every patient for at least 48 h with vs. ii) the standard of care associating COT and “late” NIV, indicated in patients with respiratory deterioration and/or PaO2/FiO2 ratio ≤ 200 mmHg. Secondary outcomes were the occurrence of chest trauma-related complications (pulmonary infection, delayed hemothorax or moderate-to-severe ARDS).ResultsStudy enrollment was stopped for futility after a 2-year study period and randomization of 141 patients. Overall, 11 patients (7.8%) required endotracheal intubation for delayed respiratory failure. The rate of endotracheal intubation was not significantly lower in patients treated with the experimental strategy (7% [5/71]) when compared to the control group (8.6% [6/70]), with an adjusted OR = 0.72 (95%IC: 0.20–2.43), p = 0.60. The occurrence of pulmonary infection, delayed hemothorax or delayed ARDS was not significantly lower in patients treated by the experimental strategy (adjusted OR = 1.99 [95%IC: 0.73–5.89], p = 0.18, 0.85 [95%IC: 0.33–2.20], p = 0.74 and 2.14 [95%IC: 0.36–20.77], p = 0.41, respectively).ConclusionA prompt association of HFNC-O2 with preventive NIV did not reduce the rate of endotracheal intubation or secondary respiratory complications when compared to COT and late NIV in high-risk blunt chest trauma patients with non-severe hypoxemia and no sign of acute respiratory failure.Clinical Trial Registration: NCT03943914, Registered 7 May 2019.

Comparison of trauma scoring system in predicting post-surgical fixation outcomes of traumatic rib fracture

Background: Several trauma scoring systems have been widely used to determine the prognosis of trauma patients, but their use for post-surgical fixation of traumatic rib fracture patients has not yet been reported. This study aimed to compare several trauma scoring systems in predicting post-surgical fixation outcomes of traumatic rib fractures. Methods: A retrospective analytical study was conducted at a single tertiary hospital. Inclusion criteria were patients who suffered multiple rib fractures and were eligible for surgical rib fixation from January 2019 to July 2022. The outcomes of the study were the length of hospitalization (LHS) and intensive care unit stay (LICU), duration of thoracostomy tube insertion (DTT), the need for mechanical ventilation (NMV), and mortality post-surgery. The correlations of trauma scoring systems and measured outcomes were evaluated by bivariate and multivariate analysis. Cut-off values were determined utilizing a receiver operating characteristic curve. Results: The study involved 110 patients. All measured trauma scores were significantly correlated with the measured outcomes. Injury Severity Score (ISS) performed better to predict LHS (p=0.004) and DTT (p=0.007). Revised Trauma Score (RTS) was a good predictor of LICU (p≤0.001) and NMV (p=0.001; OR=0.39). Thoracic Trauma Severity Score (TTSS) was independent predictor of mortality (p=0.015; OR=2.28) and the NMV post-surgery (p=0.047; OR=1.320). Conclusion: Patients who have suffered severe thoracic trauma should be assessed using trauma scores, which may predict various in-hospital outcomes and should be used complementarily with other trauma scoring systems to minimize the incidence of mortality and morbidity.

Surgical and perioperative management of flail chest with titanium plates: a French cohort series from a thoracic referral center

BackgroundThe development of titanium claw plates has made rib osteosynthesis easy to achieve and led to a renewed interest for this surgery. We report the management of patients referred to the intensive care unit (ICU) of a referral center for surgical rib fracture fixation (SRFF) after chest trauma.MethodsWe performed a retrospective observational cohort study describing the patients’ characteristics and analyzing the determinants of postoperative complications.ResultsFrom November 2013 to December 2016, 42 patients were referred to our center for SRFF: 12 patients (29%) had acute respiratory failure, 6 of whom received invasive mechanical ventilation. The Thoracic Trauma Severity Score (TTSS) was 11.0 [9–12], with 7 [5–9] broken ribs and a flail chest in 92% of cases. A postoperative complication occurred in 18 patients (43%). Five patients developed ARDS (12%). Postoperative pneumonia occurred in 11 patients (26%). Two patients died in the ICU. In multivariable analysis, the Thoracic Trauma Severity Score (TTSS) (OR = 1.89; CI 95% 1.12–3.17; p = 0.016) and the Simplified Acute Physiology Score II without age (OR = 1.17; CI 95% 1.02–1.34; p = 0.024) were independently associated with the occurrence of a postoperative complication.ConclusionThe TTSS score appears to be accurate for determining thoracic trauma severity. Short and long-term benefit of Surgical Rib Fracture Fixation should be assessed, particularly in non-mechanically ventilated patients.

The practicality of interleukin-6 in prognosis of blunt chest trauma in Korea: a retrospective study

Purpose: There are many studies on the practicality of interleukin-6 (IL-6) as a prognostic predictor in patients with multiple severe traumas. However, few studies focus on the practicality of IL-6 in patients with chest trauma. So, this study investigated whether IL-6 is effective as a prognostic factor in patients with blunt chest trauma.Methods: A total of 44 blunt chest trauma patients who visited the regional trauma center from July to December 2021 were included in this retrospective study. Blood IL-6 levels were measured immediately after emergency room admittance (IL-6 E) and 24 hours after trauma (IL-6 24). To determine whether IL-6 levels can predict the clinical course and prognosis of patients with blunt chest trauma, the correlation between IL-6 (IL-6 E and IL-6 24) and the trauma score system, Injury Severity Score, Thoracic Trauma Severity Score, and Pulmonary Contusion Score, intensive care unit (ICU) stay period, and total hospitalization period were analyzed.Results: IL-6 E showed a good correlation with Injury Severity Score (P=0.505), Thoracic Trauma Severity Score (P=0.597), Pulmonary Contusion Score (P=0.493), ICU stay period (P=0.762), and total hospitalization period (P=0.662). However, IL-6 24 had a relatively low correlation compared to IL-6 E. Therefore, IL-6 E showed useful results for predicting the prognosis of patients with blunt chest trauma.Conclusions: Early plasma IL-6 levels (IL-6 E) can predict the injury severity of blunt chest trauma, length of ICU stay, and total hospitalization period.

Changes in extracellular cytokines in predicting disease severity and final clinical outcome of patients with blunt chest trauma

BackgroundChest trauma causes substantial morbidity and mortality and its severity is assessed using clinical diagnosis or scoring systems like Injury severity score (ISS) and thoracic trauma severity score (TTSS). Association of inflammatory cytokines with severity of disease and final clinical outcome is not clearly defined in patients with chest trauma. In this study, we thought to evaluate the inflammatory response in serum and bronchoalveolar lavage fluid (BALF) in chest trauma patients and correlate the level of extracellular cytokines with diseases severity and final outcome. MethodsA total of 65 patients with blunt chest trauma and 30 healthy controls were enrolled in this prospective observational study. Assessment of inflammatory cytokines such as Interleukin (s) - IL-5, IL-13, IL-2, IL-6, IL-9, IL-1β, IFN-γ, TNF-α, IL-17A, IL-17F,IL-4, IL-21 and IL-22 was performed in both serum and bronchoalveolar lavage fluid using 13-plex multiplex kit using fluorescence–encoded bead based immunoassays. ResultsA significantly higher level of IL-13, IL-2, IL-6, IL-9, IL-1β, IFN-γ, TNF-α, IL-17A, IL-17F, IL-21 and IL-22 cytokines were observed in patients with blunt chest trauma compared to healthy controls. Level of IL-2, IL-6, IL-1β and IL-17A was significantly raised in the patients with blunt chest trauma who had a fatal outcome during the hospital stay. An elevated cytokine response of IL-13, IL-4, and IL-21 was noted in the group of patients with high (>5) thoracic trauma severity score. ConclusionRoutine monitoring of the inflammatory cytokine level in patients with chest trauma may be used routinely. Longer prospective studies should be encouraged to determine the role of cytokines in patients with chest trauma in predicting the patient final clinical outcome.

High-flow nasal cannula therapy for acute respiratory failure in patients with chest trauma: A single-center retrospective study

PurposeThis retrospective study was performed to investigate the utility of high-flow nasal cannula (HFNC) therapy in patients with chest trauma and identify the risk factors associated with treatment failure. Materials and methodsWe identified 44 acute respiratory failure patients with chest trauma who received HFNC therapy between June 2016 and March 2019 at the Fourth Affiliated Hospital of Nantong University. According to their response to HFNC therapy, the patients were divided into success and failure groups. Their medical records were reviewed retrospectively to identify useful risk factors for HFNC treatment failure. ResultsOf the 44 patients, 25 and 19 patients were assigned to the HFNC success and failure groups, respectively. Compared with the success group, the failure group had a significantly higher rate of multiple rib fractures/flail chest (P = 0.035), higher Thoracic Trauma Severity Score (TTSS) (P = 0.001) and significantly longer ICU stay (P = 0.006) and hospital stay (P = 0.001). The mortality rate of the failure group was higher than that of the success group, but there was no significant difference (P = 0.414). High TTSS was a significant risk factor for treatment failure. The AUC of TTSS was 0.793. The cut-off value for TTSS was 14 points (sensitivity: 0.68, specificity: 0.84). ConclusionsHFNC therapy was safe and effective in patients with chest trauma, and more than 50% of the patients successfully recovered from acute respiratory failure without invasive ventilation. A high TTSS could be a significant risk factor for HFNC treatment failure and had a high predictive performance.

Predicting Outcomes After Blunt Chest Trauma-Utility of Thoracic Trauma Severity Score, Cytokines (IL-1β, IL-6, IL-8, IL-10, and TNF-α), and Biomarkers (vWF and CC-16).

Thoracic trauma severity score (TTSS) has been used to assess severity and risk of pulmonary complications in patients with chest trauma. The role of cytokines and biomarkers in patients with chest trauma and its association with TTSS is not well elucidated. The aim of the study was to assess the cytokines (IL-1β, IL-6, IL-8, IL-10, and TNF-α) and biomarkers (vWF, CC-16) in patients of thoracic trauma and correlate it with TTSS and patient’s outcome. This was a prospective observational study. Serum and bronchoalveolar lavage fluid samples were collected from chest trauma patients. TTSS was calculated in all patients. Suitable controls for serum and bronchoalveolar lavage (BAL) sample were selected. The outcome parameters included patient discharge or death, duration of hospital, and intensive care unit (ICU) stay. Forty-three patients were included. There was no significant correlation between the measured cytokines and biomarkers and TTSS. The mean TTSS of patients who had a fatal outcome was significantly higher than the patients who recovered. Patients with a high TTSS score had a significant prolonged ICU stay. Patients with a prolonged hospital stay had lower values of CC-16. TTSS is a useful tool to predict severity of chest trauma and prolonged ICU stay. Lower levels of CC-16 in BAL fluid of chest trauma patients were associated with prolonged hospital stay suggestive of its protective role in the airway. Longer prospective studies are required to determine the role of cytokines and biomarkers in patients with thoracic trauma in predicting the patient’s outcome.

A study to validate thoracic trauma severity score in chest trauma patients

Background: Aim of this study was to validate thoracic trauma severity score (TTSS) in assessing the requirement of mechanical ventilation, mortality, and predicting prognosis in chest injury patients.Methods: This study was conducted in department of general surgery, Dr. S. N. Medical College, Jodhpur, Rajasthan, from December 2018 to September 2019. This was a single centred, prospective, observational study, conducted in 110 patients, aged &gt;18 years, of isolated chest injury, excluding polytrauma patients. Data was summarized in the form of proportions, histograms and tables to show relationships of parameters with results. Data was presented as mean±SD and proportions as appropriate. Chi square test, z test or t tests were used wherever necessary for association analysis between categorical variables. Diagnostic test characteristics for mortality and complications was calculated from the ROC curves. A two sided of p values of less than 0.05 was considered statistically significant.Results: Most common mode of chest injury was blunt trauma and most common age group affected was 42-54 years. Maximum mortality was seen in TTSS between 16-20, shows higher the TTSS more the mortality. Ventilator requirement was more in high TTSS. Patients with higher TTSS had longer hospital stay as compared to patients with lower TTSS.Conclusions: On application of TTSS on admission, TTSS had direct correlation with need for oxygenation, ventilator need, duration of hospital stay, mortality or outcome in chest trauma patients. Thus we recommend TTSS as a good useful score for evaluation of prognosis, outcome and mortality in chest trauma patients.

Assessment of Isolated Blunt Chest Trauma Patients in Benha University Hospital According to Thoracic Trauma Severity Score

Background: Chest trauma, in the younger population, is considered a significant cause of morbidity and mortality. A scoring system that can give us a prediction of the thorax related complications in thoracic trauma patients is especially needed. So, the Thoracic Trauma Severity Score (TTSS) was described. The aim of this work: To assess the validity of the Thoracic Trauma Severity Score and its efficacy to predict outcome in blunt thoracic trauma patients. Methodology: Our study included 160 patients of isolated blunt chest trauma attending to emergency room at Benha University Hospital. Results: TTSS when larger than or equal 8 is a good test for prediction of outcome as sensitivity of it reaches 92.3% while specificity is 100% with 97.5% accuracy. Conclusion: This study shows how the usefulness of the TTSS for predicting outcome in thoracic trauma patients, as poor outcome was associated with higher scores. Keywords: Thorax trauma severity score; Blunt thoracic trauma; Trauma outcome

Application of automated bronchial 3D-CT measurement in pulmonary contusion complicated with acute respiratory distress syndrome.

BACKGROUNDQuantitative measurement of bronchial morphological changes in pulmonary contusion with acute respiratory distress syndrome (ARDS) has important clinical implications.OBJECTIVETo investigate the morphological changes in bronchus before and after treatment in patients with pulmonary contusion combined with ARDS using an automated bronchial three-dimensional computed tomography (3D-CT) measurement method.METHODSThe study involves a dataset of CT images of 62 patients diagnosed with pulmonary contusion combined with ARDS. The volume of pulmonary contusion lesions was calculated as a percentage of the total lung volume using the automated 3D-CT method. The bronchial luminal cross-sectional area, wall cross-sectional area, the maximum and average wall thickness, the maximum and average luminal densities, intraluminal and extraluminal diameters, and circumferences of generations 2-4 bronchi before and after treatment were measured. Furthermore, the corresponding differences were analyzed statistically.RESULTSThe luminal cross-sectional area, wall cross-sectional area, intraluminal and extraluminal diameters, and circumferences of generations 2-4 bronchi were all significantly lower before treatment than after treatment (P < 0.05). However, the maximum and average wall thicknesses were both significantly higher before treatment than after treatment (P < 0.05). No significant difference was found in the maximum and average luminal densities before and after treatment (P > 0.05). The percentage of the pulmonary contusion lesion volume to the total lung volume correlated positively with the thoracic trauma severity score (r = 0.74, P < 0.01).CONCLUSIONSQuantitative bronchial CT image analysis enables to detect and assess bronchial morphological changes in patients diagnosed with pulmonary contusion combined with ARDS.

Chest Trauma Scoring Systems for Predicting Respiratory Complications in Isolated Rib Fracture

BackgroundWe retrospectively compared chest trauma scoring systems in patients with rib fractures without major extrathoracic injury for predicting respiratory complications. We also evaluated the predictive power according to the presence or absence of pulmonary contusion. Materials and methodsData from 177 patients with isolated rib fractures were included (December 2013 to April 2018). The primary outcome was respiratory complications (pneumonia, respiratory failure, or empyema). The Abbreviated Injury Scale (AIS), Thoracic Trauma Severity Score (TTSS), Chest Trauma Score (CTS), Rib Fracture Score (RFS), and RibScore were evaluated using univariate and receiver operating characteristic (ROC) analyses to determine their predictive value for pulmonary complications. We divided patients into two groups according to the presence or absence of pulmonary contusion, and constructed ROC curves for both groups. ResultsTwenty-eight patients (15.8%) had ≥1 respiratory complication, with significantly higher numbers of standard, segmental, and displaced rib fractures as well as significantly higher TTSS, CTS, RFS, and AIS scores. In all patients, the TTSS (0.723, 95% confidence interval [CI] 0.651-0.788) showed the highest area under the ROC curve (AUROC), followed by the CTS, RFS, AIS, and RibScore. In patients with pulmonary contusion, TTSS also showed the highest AUROC (0.704, 95% CI 0.613-0.784). In patients without pulmonary contusion, RFS showed the highest AUROC (0.759, 95% CI 0.630-0.861). ConclusionsTTSS was the most useful system for predicting respiratory complications in isolated rib fracture patients with pulmonary contusion. By contrast, RFS was the most useful in patients without pulmonary contusion.

Management of traumatic flail chest in intensive care unit: An experience from trauma center ICU.

Background/Aim:The thoracic injury and related complications are responsible for upto 25% of blunt trauma mortality. This study is designed to compare these two popular ventilation modes in traumatic flail chest.Materials and Method:A total of 30 patients with thoracic trauma, aged 18–60 years, were enrolled in this study for a period of 1 year. The Thoracic Trauma Severity Score (TTSS) was used for assessing the severity of chest injury. Patients were divided into two treatment groups: one recieved endotracheal intubation with mechanical ventilation (ET group, n = 15) and another recieved noninvasive ventilation (NIV group, n = 15). All patients were observed for the duration of ventilatory days, complications such as pneumonia and sepsis, length of the stay in ICU, and mortality. Statistical analysis was done using statistical software SPSS for windows (Version 16.0).Results:There were no significant differences in age, sex, weight, and length of the stay in ICU in between the two groups. Rate of complications was significantly higher in ET group. Oxygenation was significantly improved in NIV group within 24 hr, later it become equivalent to the ET group patients while the pCO2 level was significantly lower in ET group compared with NIV group. Analgesia in both the groups is maintained to keep the visual analog scale (VAS) score below 2 and was comparable in both the groups.Conclusions:The endotracheal intubation is also associated with serious complications as compared to NIV. The use of NIV in appropriate patients decreases complications, mortality, length of the stay in ICU, the use of resources, and cost.

Long-term disability after blunt chest trauma: Don’t miss chronic neuropathic pain!

Introduction The main objective of this prospective study was to assess the incidence of chronic pain and long-term respiratory disability in a single-center cohort of severe blunt chest trauma patients.Methods Over a 10-month period, all consecutive blunt chest trauma patients admitted in Intensive Care Unit (ICU) were screened to participate in a 3-month and 12-month follow-up. The following variables were prospectively assessed: persistence of chronic chest pain requiring regular used of analgesics, neuropathic pain, respiratory disability, physical and mental health status. Univariate and multivariable analysis were conducted to assess variables associated with chronic chest pain, neuropathic chest pain and respiratory disability.Results During the study period, 65 patients were included in the study. Chronic chest pain and respiratory disability were reported in 62% and 57% of patients respectively at 3 months postinjury. Neuropathic pain was reported in 22% of patients, associated with higher impairment of quality of life. A thoracic trauma severity score ≥12 and a pain score ≥4 at SICU discharge were the only variables significantly associated with the occurrence of neuropathic pain at 3 months (OR = 7 [2–32], p = 0.01 and OR = 16 [4–70], p < 0.0001).Conclusion According to the current study, chronic pain and long-term respiratory disability are very common after severe blunt chest trauma patients. Special attention should be paid to neuropathic pain, frequently under-diagnosed and responsible for significant impairment of quality of life.

Risk factors for prolonged mechanical ventilation in patients with severe multiple injuries and blunt chest trauma: a single center retrospective case-control study.

AimBlunt chest trauma is common and is associated with morbidity and mortality in patients with multiple injuries, frequently requiring invasive mechanical ventilation. The aim of this study was to elucidate risk factors for prolonged mechanical ventilation (PMV).MethodsConsecutive adult patients with multiple severe injuries and blunt chest trauma who treated in Chiba Emergency Medical Center (Chiba, Japan) between January 2008 and December 2015 were enrolled in this retrospective chart‐review study. According to ventilatory time, the patients were divided into PMV (≥7 days) and shortened mechanical ventilation (SMV; <7 days) groups. Thoracic Trauma Severity Score (TTSS) was calculated. To identify risk factors for PMV, univariate and multivariate logistic analyses and receiver operating characteristic analysis were carried out.ResultsEighty‐four and 49 patients were assigned to PMV and SMV groups, respectively. Compared with the SMV group, the PMV group had a significantly larger number of fractured ribs (P < 0.01), higher rate of severe Glasgow Coma Scale (GCS ≤8) (P < 0.05) and flail chest (P < 0.001), higher TTSS (P < 0.001), or longer intensive care unit and hospital stay (both P < 0.001). Logistic analysis showed that severe GCS (odds ratio [OR] = 4.6, P < 0.01), flail chest (OR = 3.0, P < 0.05), and TTSS (OR = 1.2; P < 0.01) were independent significant risk factors. Receiver operating characteristic analyses showed that the area under the curves for TTSS, flail chest, and severe GCS were 0.74, 0.70, and 0.58, respectively. When the three factors were combined, the area under the curve increased to 0.8.ConclusionSevere GCS (≤8), flail chest, or TTSS may be independent risk factors. Combining the three risk factors could provide high predictive performance for PMV.

Role of angiotensin-converting enzyme as prognostic marker in thoracic trauma: A prospective observational study.

Chest injuries, accounting for 25% of all trauma-related deaths, are one of the main causes of death in young adults. Our priority is the early identification of life-threatening injuries both immediate and delayed. The role of various biomarkers, such as Clara cell protein 16, von Willebrand factor, interleukin-6, tumor necrosis factor, and angiopoietin, has been studied in trauma-related acute respiratory distress syndrome (ARDS). Serum angiotensin-converting enzyme (ACE) levels have been studied in non-trauma-related ARDS. The aim of this prospective observational study was to evaluate the role of ACE levels as a prognostic marker in thoracic trauma. A prospective observational study was conducted to evaluate serum ACE levels in thoracic trauma patients and to explore its prognostic potential with regard to clinical outcome. A total of 48 thoracic trauma patients were included in the study. The mean ACE level in the study population was 66.54+-11.18. A strong positive correlation was found among serum ACE levels and Thoracic Trauma Severity Score (TTSS). Our study demonstrates that serum ACE levels are increased in thoracic trauma patients with higher levels, indicating the severe nature of trauma in concordance with increased TTSS scores.

Risk Factors for Pneumonia in Ventilated Trauma Patients with Multiple Rib Fractures.

BackgroundVentilator-associated pneumonia (VAP) is a common disease that may contribute to morbidity and mortality among trauma patients in the intensive care unit (ICU). This study evaluated the associations between trauma factors and the development of VAP in ventilated patients with multiple rib fractures.MethodsWe retrospectively and consecutively evaluated 101 patients with multiple rib fractures who were ventilated and managed at our hospital between January 2010 and December 2015, analyzing the associations between VAP and trauma factors in these patients. Trauma factors included sternal fracture, flail chest, diaphragm injury, traumatic aortic dissection, combined cardiac injury, pulmonary contusion, pneumothorax, hemothorax, hemopneumothorax, abbreviated injury scale score, thoracic trauma severity score, and injury severity score.ResultsForty-six patients (45.5%) had at least 1 episode of VAP, 10 (21.7%) of whom died in the ICU. Of the 55 (54.5%) patients who did not have pneumonia, 9 (16.4%) died in the ICU. Using logistic regression analysis, we found that VAP was associated with severe lung contusion (odds ratio, 3.07; 95% confidence interval, 1.12 to 8.39; p=0.029).ConclusionSevere pulmonary contusion (pulmonary lung contusion score 6–12) is an independent risk factor for VAP in ventilated trauma patients with multiple rib fractures.

EVALUATION OF THORACIC TRAUMA SEVERITY SCORE IN PREDICTING THE OUTCOME OF ISOLATED BLUNT CHEST TRAUMA PATIENTS

Background: Chest trauma is a significant cause of mortality and morbidity, especially in the younger population. Injuries to the thorax are the third most common injuries in trauma patients, next to injuries to the head and extremities. Outcome and prognosis for the great majority of patients with chest trauma are excellent. There are many predictors of mortality in chest trauma patients however; the present standards for assessing thoracic trauma vary widely. For this in 2000 Pape et al developed the Thoracic Trauma Severity Score (TTSS), which combines the patient's age, resuscitation parameters, and radiological assessment of the thorax. Aim of this study: was to assess the validity if any; of the Thorax trauma severity score and its ability to predict mortality in blunt chest trauma patients. Methodology: this was a cross sectional study, the study included 30 patients. Results: the (TTSS) was found to be a good predictor for mortality among the studied patients on initial evaluation; with a score larger than (7), the score is 100% sensitive and 100% specific for prediction of poor outcome (Death and ICU admission) versus good outcome (Discharge from ER and inpatient admission) with 100% positive predictive value and 100% negative predictive value. Conclusion: This study supports the use of the TTSS for predicting mortality in thoracic injury patients, as higher scores were associated with higher mortality and morbidity.

Thoracic Trauma Severity score on admission allows to determine the risk of delayed ARDS in trauma patients with pulmonary contusion.

Pulmonary contusion is a major risk factor of acute respiratory distress syndrome (ARDS) in trauma patients. As this complication may appear after a free interval of 24-48 h, detection of patients at risk is essential. The main objective of this study was to assess the performance of the Thoracic Trauma Severity (TTS) score upon admission in predicting delayed ARDS in blunt trauma patients with pulmonary contusion. All blunt thoracic trauma patients admitted consecutively to our trauma centre between January 2005 and December 2009 were retrospectively included if they presented a pulmonary contusion on the admission chest computed tomography scan. Main outcome measure was the presence of moderate or severe ARDS (PaO2/FiO2 ratio≤200) for 48 h or more. The global ability of the TTS score to predict ARDS was studied by ROC curves with a threshold analysis using a grey zone approach. Of 329 patients studied (75% men, mean age 36.9 years [SD 17.8 years], mean Injury Severity Score 21.7 [SD 16.0]), 82 (25%) presented with ARDS (mean lowest PaO2/FiO2 ratio of 131 [SD 34]). The area under the ROC curves for the TTS score in predicting ARDS was 0.82 (95% CI 0.78-0.86) in the overall population. TTS scores between 8 and 12 belonged to the inconclusive grey zone. A TTS score of 13-25 was found to be independent risk factors of ARDS (OR 25.8 [95% CI 6.7-99.6] P<0.001). An extreme TTS score on admission accurately predicts the occurrence of delayed ARDS in blunt thoracic trauma patients affected by pulmonary contusion. This simple score could guide early decision making and management for a non-negligible proportion of this specific population.