Predicting outcomes after blunt chest wall trauma: development and external validation of a new prognostic model

Battle, Ceri; Lovett, S; Hutchings, Hayley; Evans, P A

doi:10.1186/cc13254

Cited by 13 publications

(16 citation statements)

References 2 publications

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“…To use our prognostic model for making clinical decisions, we derived a risk score using optimism-adjusted coefficients. 22 To make the risk score clinically interpretable, coefficients were standardised and rounded. 22 Individual patient risk scores were calculated.…”

Section: Discussionmentioning

confidence: 99%

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Development of a Clinical Decision Rule for the Early Safe Discharge of Patients with Mild Traumatic Brain Injury and Findings on Computed Tomography Brain Scan: A Retrospective Cohort Study

Marincowitz

Lecky

Allgar

et al. 2020

Journal of Neurotrauma

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International guidelines recommend routine hospital admission for all patients with mild traumatic brain injury (TBI) who have injuries on computed tomography (CT) brain scan. Only a small proportion of these patients require neurosurgical or critical care intervention. We aimed to develop an accurate clinical decision rule to identify low-risk patients safe for discharge from the emergency department (ED) and facilitate earlier referral of those requiring intervention. A retrospective cohort study of case notes of patients admitted with initial Glasgow Coma Scale 13-15 and injuries identified by CT was completed. Data on a primary outcome measure of clinically important deterioration (indicating need for hospital admission) and secondary outcome of neurosurgery, intensive care unit admission, or intubation (indicating need for neurosurgical admission) were collected. Multi-variable logistic regression was used to derive models and a risk score predicting deterioration using routinely reported clinical and radiological candidate variables identified in a systematic review. We compared the performance of this new risk score with the Brain Injury Guideline (BIG) criteria, derived in the United States. A total of 1699 patients were included from three English major trauma centers. A total of 27.7% (95% confidence interval [CI], 25.5-29.9) met the primary and 13.1% (95% CI, 11.6-14.8) met the secondary outcomes of deterioration. The derived clinical decision rule suggests that patients with simple skull fractures or intracranial bleeding <5 mm in diameter who are fully conscious could be safely discharged from the ED. The decision rule achieved a sensitivity of 99.5% (95% CI, 98.1-99.9) and specificity of 7.4% (95% CI, 6.0-9.1) to the primary outcome. The BIG criteria achieved the same sensitivity, but lower specificity (5%). Our empirical models showed good predictive performance and outperformed the BIG criteria. This would potentially allow ED discharge of 1 in 20 patients currently admitted for observation. However, prospective external validation and economic evaluation are required.

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Section: Discussionmentioning

confidence: 99%

“…22 To make the risk score clinically interpretable, coefficients were standardised and rounded. 22 Individual patient risk scores were calculated. A risk score for ED discharge was proposed based on the trade-off between risk of deterioration in a discharged patient and number of patients admitted for observation.…”

Section: Discussionmentioning

confidence: 99%

Development of a Clinical Decision Rule for the Early Safe Discharge of Patients with Mild Traumatic Brain Injury and Findings on Computed Tomography Brain Scan: A Retrospective Cohort Study

Marincowitz

Lecky

Allgar

et al. 2020

Journal of Neurotrauma

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“…One example being extended rib fractures in terms of a flail chest, which may result in thoracic instability with consecutive respiratory dysfunction. Recent publications have shown that the distribution of the fractures and the number of broken ribs correlate with a higher rate of posttraumatic complications and higher mortality [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Enhanced reading time efficiency by use of automatically unfolded CT rib reformations in acute trauma

Bier

Schabel

Othman

et al. 2015

European Journal of Radiology

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“…To this end, several scoring systems have been developed. The Rib Score (RS), 7 Rib Fracture Score (RFS), 8 Chest Trauma Score (CTS), 9 Thoracic Trauma Severity Score (TTSS), 10 and Battle Score 11 were all designed to either characterize the degree of chest wall injury or predict future complications. Of these, only the Battle score developed the weights for its predictor variables using a regression model, and it is the only score which has retained its discriminative ability during external validation.…”

Section: Introductionmentioning

confidence: 99%

Revised Intensity Battle Score (RIBS): Development of a Clinical Score for Predicting Poor Outcomes After Rib Fractures

Buchholz

Jia

Manea

et al. 2022

The American Surgeon™

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Background Patients with rib fractures have variable clinical courses and it is difficult to predict which patients will do poorly. Ideally this prediction would happen at the time of admission to facilitate effective triage. One scoring system devised to this end, is the Battle score. This study aims to evaluate the efficacy of the Battle score as triage tool, and to re-tool it for performance in an inpatient trauma setting. Methods A multivariate logistic regression model was trained on patients admitted to a level one trauma center with at least one rib fracture. A composite outcome was used to classify those who had poor outcomes. Eighteen candidate predictors were analyzed in univariate analysis, then the most promising fed into the logistic model until a triage score was built and internally validated by bootstrapping. Results Of the 838 patients who met the inclusion criteria, 145 (17.3%) patients had a defined poor outcome. The relevant predictors included in the final scoring system were number of ribs fractured, chest tube, pulmonary contusions, chronic obstructive pulmonary disease, and Glasgow coma score. Age was not found to be predictive. This score was found to have higher fidelity in predicting poor outcomes than the original Battle score (AUROC .858 vs .649.) Discussion An easy to calculate clinical scoring system was created to triage patients with rib fractures at the time of admission. Age may be of less importance than previously thought, while injury burden and history of lung disease may play a larger role.

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Predicting outcomes after blunt chest wall trauma: development and external validation of a new prognostic model

Cited by 13 publications

References 2 publications

Development of a Clinical Decision Rule for the Early Safe Discharge of Patients with Mild Traumatic Brain Injury and Findings on Computed Tomography Brain Scan: A Retrospective Cohort Study

Development of a Clinical Decision Rule for the Early Safe Discharge of Patients with Mild Traumatic Brain Injury and Findings on Computed Tomography Brain Scan: A Retrospective Cohort Study

Enhanced reading time efficiency by use of automatically unfolded CT rib reformations in acute trauma

Revised Intensity Battle Score (RIBS): Development of a Clinical Score for Predicting Poor Outcomes After Rib Fractures

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