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

Abstract

IntroductionBlunt chest wall trauma accounts for over 15% of all trauma admissions to Emergency Departments worldwide. Reported mortality rates vary between 4 and 60%. Management of this patient group is challenging as a result of the delayed on-set of complications. The aim of this study was to develop and validate a prognostic model that can be used to assist in the management of blunt chest wall trauma.MethodsThere were two distinct phases to the overall study; the development and the validation phases. In the first study phase, the prognostic model was developed through the retrospective analysis of all blunt chest wall trauma patients (n = 274) presenting to the Emergency Department of a regional trauma centre in Wales (2009 to 2011). Multivariable logistic regression was used to develop the model and identify the significant predictors for the development of complications. The model’s accuracy and predictive capabilities were assessed. In the second study phase, external validation of the model was completed in a multi-centre prospective study (n = 237) in 2012. The model’s accuracy and predictive capabilities were re-assessed for the validation sample. A risk score was developed for use in the clinical setting.ResultsSignificant predictors of the development of complications were age, number of rib fractures, chronic lung disease, use of pre-injury anticoagulants and oxygen saturation levels. The final model demonstrated an excellent c-index of 0.96 (95% confidence intervals: 0.93 to 0.98).ConclusionsIn our two phase study, we have developed and validated a prognostic model that can be used to assist in the management of blunt chest wall trauma patients. The final risk score provides the clinician with the probability of the development of complications for each individual patient.

When will pulmonary function recover after rib fracture?

“…Most rib fractures healed with conservative treatment without any particular complications. Pain relief is subjective and can vary depending on individual differences and the pain management method; however, the course and degree of recovery from a rib fracture can be quantified by objective indices such as periodic radiological diagnostic testing, pulmonary function testing, and oxygen saturation testing (Battle et al, 2014). According to Bakhos et al (2006) and Carver et al (2015), VC is a prognostic marker in older rib fracture patients that shows pulmonary complications that may lead to the need for a long-term care facility after hospital discharge.…”

“…According to Bakhos et al (2006) and Carver et al (2015), VC is a prognostic marker in older rib fracture patients that shows pulmonary complications that may lead to the need for a long-term care facility after hospital discharge. Moreover, Battle et al (2014) reported that the oxygen saturation level can be used as a novel prognostic marker. In the present study, we found no statistically significant improvement in lung function based on age, number of fractures, and ICNB.…”

A Preventative Respiratory Protocol to Identify Trauma Subjects at Risk for Respiratory Compromise on a General In-Patient Ward

“…[1][2][3][4][5][6][7][8][9][10] Respiratory complications can lead to adverse hospital events, such as unplanned admission to the ICU, prolonged hospital stays, higher rates of mortality, and increased consumption of healthcare resources. [11][12][13][14][15] Many adverse events are preventable.…”

Protocol for a multicentre randomised feasibility STUdy evaluating the impact of a prognostic model for Management of BLunt chest wall trauma patients: STUMBL trial

“…[1][2][3][4] Clinical symptoms are not considered by most clinicians to be an accurate predictor of outcome following non-life-threatening blunt chest wall trauma. [1][2][3][4][5][6][7] Decisions regarding the appropriate level of care required by the patient following discharge from the ED are therefore difficult, which is further compounded by the lack of current national guidelines. An improvement in the ability to identify the Protocol strengths and limitations of this study ► The main strength of the trial design is that it will test all of the methodological components of the future definitive trial, including the trial infrastructure, randomisation process, data management system, both qualitative and quantitative analysis, follow-up procedures and a health economic analysis.…”