Risk Score for Predicting Mortality in Flail Chest

Zehr, Meaghan; Klar, Neil; Malthaner, Richard

doi:10.1016/j.athoracsur.2015.03.090

Cited by 9 publications

(6 citation statements)

References 27 publications

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“…These data were consistent with a trend toward increasing mortality identified in older patients in an analysis by Freedland and colleagues [5]. In a risk score designed to predict mortality after flail chest injury, age was one of five elements included in the model [9]. These data support a wider body of literature that older patients are at increased mortality risk after trauma and should therefore be targeted with a lower threshold for close monitoring and early, aggressive management [10][11][12][13][14].…”

Section: Discussionsupporting

confidence: 78%

Flail Chest: Less Deadly than Originally Thought

et al. 2018

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Section: Discussionsupporting

confidence: 78%

Flail Chest: Less Deadly than Originally Thought

et al. 2018

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“…Therefore, the final model comprised these 6 variables only (including 2 clinical features, and 4 angiographic characteristics). Although not all 6 variables were significantly predictive when applied individually, the ORs for each were higher than 1.2, and the final model performed better when all were included than when they were not [14,15]. We assigned points by propensity to the adjusted ORs using the Charlson method.…”

Section: Resultsmentioning

confidence: 99%

“…Scoring points were assigned with reference to the method of Charlson et al [14]. Scoring in our CTO model is determined as follows: if the OR is ≥1.2 but <1.5, 1 point is assigned; if the OR is ≥1.5 but <2.5, 2 points are assigned; if the OR is ≥2.5 but <3.5, 3 points are assigned [15]. In addition, the discriminatory performance of the model was tested by ROC curve analysis.…”

Section: Methodsmentioning

confidence: 99%

Predicting Successful Recanalization in Patients with Native Coronary Chronic Total Occlusion: The Busan CTO Score

Jin

Kim

et al. 2017

Cardiology

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Background: The optimal strategy to manage chronic total occlusion (CTO) remains unclear. The Japanese CTO multicenter registry (J-CTO) score is an established tool for predicting successful recanalization. However, it does not take into account nonangiographic predictors for final technique success. In the present study, we designed and tested a scoring model called the Busan single-center CTO registry (B-CTO) score combining clinical and angiographic characteristics to predict successful CTO recanalization in Korean patients. Methods: Prospectively enrolled CTO patients (n = 438) undergoing coronary intervention (1999-2015) were assessed. The B-CTO score comprises 6 independent predictors: age 60-74 years and lesion length ≥20 mm were assigned 1 point each, while age ≥75 years, female gender, lesion location in the right coronary artery, blunt stump, and bending >45° were assigned 2 points each. For each predictor, the points assigned were based on the associated odds ratio by multivariate analysis. The lesions were classified into 4 groups according to the summation of points scored to assess the probability of successful CTO recanalization: easy (score 0-1), intermediate (score 2-3), difficult (score 4-5), and very difficult (score ≥6). CTO opening was designated as the primary endpoint regardless of the interventional era or the skill of the operator. Results: The final success rate for B-CTO was 81.1%. The probability of successful recanalization for patient groups classified as easy (n = 64), intermediate (n = 148), difficult (n = 134), and very difficult (n = 92) was 95.3, 86.5, 79.1 and 65.2%, respectively (p for trend <0.001). When compared to the J-CTO, the B-CTO score demonstrated a significant improvement in discrimination as indicated by the area under the receiver-operator characteristic curve (AUC 0.083; 95% CI 0.025-0.141), with a positive integrated discrimination improvement of 0.042 and a net reclassification improvement of 56.0%. Conclusions: The B-CTO score has been designed and validated in Korean patients with native coronary CTO and is an improved tool for predicting successful recanalization. Wider application of the B-CTO score remains to be explored.

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“…Other complications due to FC are pneumonia, ARDS, pneumothorax, hemothorax, pulmonary contusion, chronic pain and chest wall deformity and atelectasis (1,4,22). Zehr et al (23) proposed a risk score for predicting mortality in FC; they found that the initial assessment of patients with FC could be done by using five risk factors: age, Glasgow Coma Score, ventilation, cardiopulmonary resuscitation and number of comorbidities. They proved that less than 6 points is consistent with 1% observed mortality, 6 to 10 points predicts 5% mortality, 11 to 15 points predicts 22% mortality, and 16 or more points predicts 46% mortality; only patients at low to medium risk of mortality should be candidates for operative repair.…”

Section: Why: Pathophysiology and Outcomes Of Surgerymentioning

confidence: 99%

Surgical stabilization of flail chest after trauma: when, why and how to do it?

Brascia¹,

Iaco²,

Palma³

et al. 2020

Curr Chall Thorac Surg

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Chest trauma is the third most common injury in trauma patients and its presence in the setting of multi-systemic trauma can significantly increase patients' morbidity and mortality. In up to 15% of cases, flail chest (FC) may occur as a consequence of blunt trauma; it is defined as a pathologic condition that happens "when three or more adjacent ribs are fractured in at least two places, creating a chest wall segment that moves paradoxically from the chest wall" (1,2) (Figure 1). The fast evolution to respiratory failure and death (occurring from 10 to 36% of cases), as well as late complications like pneumonia, ARDS, atelectasis, chronic pain and deformity (3,4), make the proper management

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Risk Score for Predicting Mortality in Flail Chest

Cited by 9 publications

References 27 publications

Flail Chest: Less Deadly than Originally Thought

Flail Chest: Less Deadly than Originally Thought

Predicting Successful Recanalization in Patients with Native Coronary Chronic Total Occlusion: The Busan CTO Score

Surgical stabilization of flail chest after trauma: when, why and how to do it?

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