Analysis of Scoring System to Identify High Risk Patients and their Outcome in Isolated Blunt Chest Trauma- A Prospective Observational Study

Abstract

Introduction: Chest trauma is a major cause of mortality accounting for a substantial proportion of all trauma admissions and death. In India, the reported mortality range is between 4-60% and no current national guidelines exist to assist the management of this patient group unless patient has severe immediate life threatening injuries. A scoring system for identification of patients at higher risk for development of morbidity and mortality will allow early selection of vulnerable patients, choice of an appropriate treatment protocol and therapeutic interventions. Aim: This present study aims for the analysis of a scoring system to identify patients with isolated blunt chest trauma at higher risk for morbidity and mortality, in order to prioritise intervention and improve the outcome. Materials and Methods: This was a prospective observational study conducted at the departments of emergency medicine and general surgery of a tertiary care teaching hospital in South India over a period of 18 months. The study included 85 isolated blunt chest trauma patients. We utilised a Chest Trauma Score (CTS) composed of patient factors like age, smoking, lung disease and severity factors like rib fractures, parenchymal and pleural involvement, partial pressure of oxygen/ fraction of inspired oxygen (PaO2/FiO2) ratio. CTS were applied at the time of admission after detailed assessment of all injuries. Patient was followed-up at regular intervals upto 30 days. The CTS and outcome measurements were analysed using logistic regression analysis. Results: The area under Receiver Operating Characteristic curve (ROC) was found to be 0.979 (p-value <0.001). The CTS cut-off value was ≥11.5 with 89% sensitivity and 95% specificity. In patients with CTS ≥11.5, 98.3% had associated morbidity and complications whereas only 25.9% with CTS <11.5 had associated morbidity (p-value<0.001). Number of rib fractures, pulmonary contusion and PaO2/FiO2 ratio (odds ratio 10.632, 6.007, 12.859, respectively) were found to be significant independent predictors of morbidity and complications. Conclusion: In summary, CTS ≥11.5 has shown a significant association with poor outcome. Patients who sustained isolated blunt chest trauma and together with increasing scores, had increasing incidence of morbidity and complications. The scoring system used in this study proved that it makes a useful tool to predict the outcome in thoracic trauma.