Comparison of trauma scoring system in predicting post-surgical fixation outcomes of traumatic rib fracture

Ketut Putu  Yasa; Raymen Satria; I Komang Adhi Parama  Harta; I Wayan Sudarma; I Nyoman  Semadi

doi:10.15562/bmj.v12i1.4141

Comparison of trauma scoring system in predicting post-surgical fixation outcomes of traumatic rib fracture

Ketut Putu Yasa ,

Raymen Satria ,

I Komang Adhi Parama Harta ,

I Wayan Sudarma ,

I Nyoman Semadi ,

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DOI: https://doi.org/10.15562/bmj.v12i1.4141 |
Published: 2023-02-28

Abstract

Background: Several trauma scoring systems have been widely used to determine the prognosis of trauma patients, but their use for post-surgical fixation of traumatic rib fracture patients has not yet been reported. This study aimed to compare several trauma scoring systems in predicting post-surgical fixation outcomes of traumatic rib fractures.

Methods: A retrospective analytical study was conducted at a single tertiary hospital. Inclusion criteria were patients who suffered multiple rib fractures and were eligible for surgical rib fixation from January 2019 to July 2022. The outcomes of the study were the length of hospitalization (LHS) and intensive care unit stay (LICU), duration of thoracostomy tube insertion (DTT), the need for mechanical ventilation (NMV), and mortality post-surgery. The correlations of trauma scoring systems and measured outcomes were evaluated by bivariate and multivariate analysis. Cut-off values were determined utilizing a receiver operating characteristic curve.

Results: The study involved 110 patients. All measured trauma scores were significantly correlated with the measured outcomes. Injury Severity Score (ISS) performed better to predict LHS (p=0.004) and DTT (p=0.007). Revised Trauma Score (RTS) was a good predictor of LICU (p≤0.001) and NMV (p=0.001; OR=0.39). Thoracic Trauma Severity Score (TTSS) was independent predictor of mortality (p=0.015; OR=2.28) and the NMV post-surgery (p=0.047; OR=1.320).

Conclusion: Patients who have suffered severe thoracic trauma should be assessed using trauma scores, which may predict various in-hospital outcomes and should be used complementarily with other trauma scoring systems to minimize the incidence of mortality and morbidity.

References

Chrysou K, Halat G, Hoksch B, Schmid RA, Kocher GJ. Lessons from a large trauma center: impact of blunt chest trauma in polytrauma patients-still a relevant problem? Scand J Trauma Resusc Emerg Med. 2017;25:1–6.
Peek J, Kremo V, Beks R, et al. Long-term quality of life and functional outcome after rib fracture fixation. European Journal of Trauma and Emergency Surgery 2020;48:255-64.
Sawyer E, Wullschleger M, Muller N, Muller M. Surgical Rib Fixation of Multiple Rib Fractures and Flail Chest: A Systematic Review and Meta-analysis. Journal of Surgical Research. 2022;276:221-34.
Guzzo JL, Bochicchio GV, Napolitano LM, Malone DL, Meyer W, Scalea TM. Prediction of outcomes in trauma: anatomic or physiologic parameters? J Am Coll Surg. 2005;201:891–7.
Pape HC, Remmers D, Rice J, Ebisch M, Krettek C, Tscherne H. Appraisal of early evaluation of blunt chest trauma: development of a standardized scoring system for initial clinical decision making. J Trauma Acute Care Surg. 2000; 49:496-504
Chen J, Jeremitsky E, Philp F, Fry W, Smith RS. A chest trauma scoring system to predict outcomes. Surgery. 2014;156:988-93.
Champion R, Copes S, Sacco J. A new characterization of injury severity. J Trauma. 1990;30(5):539-45.
Champion R. Trauma scoring. Scand J Surg. 2002;91:12-22.
Mommsen P, Zeckey C, Andruszkow H, et al. Comparison of Different Thoracic Trauma Scoring Systems in Regards to Prediction of Post-Traumatic Complications and Outcome in Blunt Chest Trauma. Journal of Surgical Research. 2012;176:239-47.
Daurat A, Millet I, Roustan JP, et al. Thoracic Trauma Severity score on admission allows to determine the risk of delayed ARDS in trauma patients with pulmonary contusion. Injury. 2016;47:147-53.
Seok J, Cho HM, Kim HH, et al. Chest Trauma Scoring Systems for Predicting Respiratory Complications in Isolated Rib Fracture. Journal of Surgical Research. 2019;244:84-90.
Sharma AK, Rathore SS, Verma V, Yadav P. A study to validate thoracic trauma severity score in chest trauma patients. Int Surg J. 2020;7(5):1526-9.
Casas IM, Marchante MAA, Paduraru M, Olea AIF, Nolasco A, Medina JC. Thorax Trauma Severity Score: Is it reliable for Patient’s Evaluation in a Secondary Level Hospital?. Bull Emerg Trauma. 2016;4(3):150-5.
Zahran MR, Elwahab AAEMA, El Nasr MMA, El Heniedy MA. Evaluation of the predictive value of thorax trauma severity score (TTSS) in thoracic-traumatized patients. The Cardiothoracic Surgeon. 2020;28:1-7.
Chawda MN, Hildebrand F, Pape HC, Giannoudis PV. Predicting outcome after multiple trauma: which scoring system? Injury. 2004;35: 347–58.
Esme H, Solak O, Yurumez Y, et al. The Prognostic Importance of Trauma Scoring Systems for Blunt Thoracic Trauma. The Thoracic and Cardiovascular Surgeon. 2007;55(3):190-5.
Athanassiadi K, Gerazounis M, Theakos N. Management of 150 flail chest injuries: analysis of risk factors affecting outcome. Eur J Cardiothorac Surg. 2004; 26:373–6.
Yian H, Gullahorn J, Loder T. Scoring of pediatric orthopaedic polytrauma: correlations of different injury scoring systems and prognosis for hospital course. J Pediatr Orthop. 2000;20:203–9.
Alvarez BD, Razente DM, Lacerda DAM, Lother NS, VON-Bahten LC, Stahlschmidt CMM. Analysis of the Revised Trauma Score (RTS) in 200 victims of different trauma mechanisms. Revista do Colégio Brasileiro de Cirurgiões. 2016;43(5):334-40.
Moon SH, Kim JW, Byun JH, et al. The thorax trauma severity score and the trauma and injury severity score. Medicine. 2017;96(42):P8317.

[1] Chrysou K, Halat G, Hoksch B, Schmid RA, Kocher GJ. Lessons from a large trauma center: impact of blunt chest trauma in polytrauma patients-still a relevant problem? Scand J Trauma Resusc Emerg Med. 2017;25:1–6.

[2] Peek J, Kremo V, Beks R, et al. Long-term quality of life and functional outcome after rib fracture fixation. European Journal of Trauma and Emergency Surgery 2020;48:255-64.

[3] Sawyer E, Wullschleger M, Muller N, Muller M. Surgical Rib Fixation of Multiple Rib Fractures and Flail Chest: A Systematic Review and Meta-analysis. Journal of Surgical Research. 2022;276:221-34.

[4] Guzzo JL, Bochicchio GV, Napolitano LM, Malone DL, Meyer W, Scalea TM. Prediction of outcomes in trauma: anatomic or physiologic parameters? J Am Coll Surg. 2005;201:891–7.

[5] Pape HC, Remmers D, Rice J, Ebisch M, Krettek C, Tscherne H. Appraisal of early evaluation of blunt chest trauma: development of a standardized scoring system for initial clinical decision making. J Trauma Acute Care Surg. 2000; 49:496-504

[6] Chen J, Jeremitsky E, Philp F, Fry W, Smith RS. A chest trauma scoring system to predict outcomes. Surgery. 2014;156:988-93.

[7] Champion R, Copes S, Sacco J. A new characterization of injury severity. J Trauma. 1990;30(5):539-45.

[8] Champion R. Trauma scoring. Scand J Surg. 2002;91:12-22.

[9] Mommsen P, Zeckey C, Andruszkow H, et al. Comparison of Different Thoracic Trauma Scoring Systems in Regards to Prediction of Post-Traumatic Complications and Outcome in Blunt Chest Trauma. Journal of Surgical Research. 2012;176:239-47.

[10] Daurat A, Millet I, Roustan JP, et al. Thoracic Trauma Severity score on admission allows to determine the risk of delayed ARDS in trauma patients with pulmonary contusion. Injury. 2016;47:147-53.

[11] Seok J, Cho HM, Kim HH, et al. Chest Trauma Scoring Systems for Predicting Respiratory Complications in Isolated Rib Fracture. Journal of Surgical Research. 2019;244:84-90.

[12] Sharma AK, Rathore SS, Verma V, Yadav P. A study to validate thoracic trauma severity score in chest trauma patients. Int Surg J. 2020;7(5):1526-9.

[13] Casas IM, Marchante MAA, Paduraru M, Olea AIF, Nolasco A, Medina JC. Thorax Trauma Severity Score: Is it reliable for Patient’s Evaluation in a Secondary Level Hospital?. Bull Emerg Trauma. 2016;4(3):150-5.

[14] Zahran MR, Elwahab AAEMA, El Nasr MMA, El Heniedy MA. Evaluation of the predictive value of thorax trauma severity score (TTSS) in thoracic-traumatized patients. The Cardiothoracic Surgeon. 2020;28:1-7.

[15] Chawda MN, Hildebrand F, Pape HC, Giannoudis PV. Predicting outcome after multiple trauma: which scoring system? Injury. 2004;35: 347–58.

[16] Esme H, Solak O, Yurumez Y, et al. The Prognostic Importance of Trauma Scoring Systems for Blunt Thoracic Trauma. The Thoracic and Cardiovascular Surgeon. 2007;55(3):190-5.

[17] Athanassiadi K, Gerazounis M, Theakos N. Management of 150 flail chest injuries: analysis of risk factors affecting outcome. Eur J Cardiothorac Surg. 2004; 26:373–6.

[18] Yian H, Gullahorn J, Loder T. Scoring of pediatric orthopaedic polytrauma: correlations of different injury scoring systems and prognosis for hospital course. J Pediatr Orthop. 2000;20:203–9.

[19] Alvarez BD, Razente DM, Lacerda DAM, Lother NS, VON-Bahten LC, Stahlschmidt CMM. Analysis of the Revised Trauma Score (RTS) in 200 victims of different trauma mechanisms. Revista do Colégio Brasileiro de Cirurgiões. 2016;43(5):334-40.

[20] Moon SH, Kim JW, Byun JH, et al. The thorax trauma severity score and the trauma and injury severity score. Medicine. 2017;96(42):P8317.

Comparison of trauma scoring system in predicting post-surgical fixation outcomes of traumatic rib fracture

Abstract

References

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