Validation of chest trauma scoring systems in polytrauma: a retrospective study with 1,038 patients in Korea

H. Kim, Mou Seop Lee, S. Yoon, Jonghee Han, Jin Young Lee, Junepill Seok
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Abstract

Purpose: Appropriate scoring systems can help classify and treat polytrauma patients. This study aimed to validate chest trauma scoring systems in polytrauma patients. Methods: Data from 1,038 polytrauma patients were analyzed. The primary outcomes were one or more complications: pneumonia, chest complications requiring surgery, and mortality. The Thoracic Trauma Severity Score (TTSS), Chest Trauma Score, Rib Fracture Score, and RibScore were compared using receiver operating characteristic (ROC) analysis in patients with or without head trauma. Results: In total, 1,038 patients were divided into two groups: those with complications (822 patients, 79.2%) and those with no complications (216 patients, 20.8%). Sex and body mass index did not significantly differ between the groups. However, age was higher in the complications group (64.1±17.5 years vs. 54.9±17.6 years, P<0.001). The proportion of head trauma patients was higher (58.3% vs. 24.6%, P<0.001) and the Glasgow Coma Scale score was worse (median [interquartile range], 12 [6.5–15] vs. 15 [14–15]; P<0.001) in the complications group. The number of rib fractures, the degree of rib fracture displacement, and the severity of pulmonary contusions were also higher in the complications group. In the area under the ROC curve analysis, the TTSS showed the highest predictive value for the entire group (0.731), head trauma group (0.715), and no head trauma group (0.730), while RibScore had the poorest performance (0.643, 0.622, and 0.622, respectively) Conclusions: Early injury severity detection and grading are crucial for patients with blunt chest trauma. The chest trauma scoring systems introduced to date, including the TTSS, are not acceptable for clinical use, especially in polytrauma patients with traumatic brain injury. Therefore, further revisions and analyses of chest trauma scoring systems are recommended.
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多重创伤中胸部创伤评分系统的验证:对韩国 1,038 名患者的回顾性研究
目的:适当的评分系统有助于对多发性创伤患者进行分类和治疗。本研究旨在验证多发性创伤患者的胸部创伤评分系统。方法:分析 1,038 名多发性创伤患者的数据:分析了 1,038 名多发性创伤患者的数据。主要结果是一种或多种并发症:肺炎、需要手术的胸部并发症和死亡率。在有或没有头部外伤的患者中,使用接收器操作特征(ROC)分析比较了胸部外伤严重程度评分(TTSS)、胸部外伤评分、肋骨骨折评分和肋骨评分。结果共有 1,038 名患者被分为两组:有并发症的患者(822 名,79.2%)和无并发症的患者(216 名,20.8%)。两组患者的性别和体重指数无明显差异。但并发症组患者的年龄更高(64.1±17.5 岁 vs 54.9±17.6岁,P<0.001)。并发症组头部外伤患者比例更高(58.3% vs. 24.6%,P<0.001),格拉斯哥昏迷量表评分更差(中位数[四分位间范围],12 [6.5-15] vs. 15 [14-15];P<0.001)。并发症组的肋骨骨折数量、肋骨骨折移位程度和肺挫伤严重程度也更高。在 ROC 曲线下面积分析中,TTSS 对整个组(0.731)、头部外伤组(0.715)和无头部外伤组(0.730)的预测值最高,而 RibScore 的表现最差(分别为 0.643、0.622 和 0.622) 结论:对钝性胸部创伤患者来说,早期检测和分级损伤严重程度至关重要。迄今为止推出的胸部创伤评分系统(包括 TTSS)在临床使用中,尤其是在有脑外伤的多发性创伤患者中,并不能被接受。因此,建议进一步修订和分析胸部创伤评分系统。
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审稿时长
11 weeks
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