External validation of novel Revised Intensity Battle Score and comparison of static rib fracture scoring systems

Abstract

Background This study aims to compare and externally validate the previously developed Revised Intensity Battle Score (RIBS) against other proposed scores for predicting poor outcomes after rib fractures. Methods An external validation set was assembled retrospectively, comprising 1493 adult patients with one or more rib fractures admitted to a Level 1 trauma center between 2019 and 2022. The following rib fracture scores were calculated for each patient: RIBS, Injury Severity Score, Rib Fracture Score, Chest Trauma Score and Battle score. Each was investigated to assess utility in predicting mortality, ICU upgrade, unplanned intubation and ventilator days. Performance was measured by area under the receiver operating characteristic curve. Results Of the 1493 patients who met inclusion criteria, 239 patients (16%) experienced one of more of the investigated outcomes. Generally, scores performed best at predicting mortality and ventilator days. The RIBS stood out as best predicting ‘any complication’ (AUC = 0.735) and ‘>7 ventilator days’ (AUC = 0.771). Conclusions The RIBS represents an externally validated triage score in patients with rib fractures and compares favorably to other static scoring systems. Use of this score as a triage tool may allow stratifying patients who may benefit from direct ICU admission, neuraxial anesthesia and aggressive respiratory care. Next steps include prospective investigation of how pairing these interventions with score directed triage impacts outcomes Level of Evidence Level V, Prognostic / epidemiological