Objective The aim was to evaluate the performance of thorax trauma severity score (TTSS) in predicting hospital mortality in thoracic trauma and comparing its performance with the trauma and injury severity score (TRISS).Background Because the great risk of thoracic trauma that may be life-threatening especially if uncontrolled, early management of it reduces mortality of polytraumatized patients. TTSS and TRISS were developed for the purpose of prediction of hospital mortality in thoracic trauma.Patients and methods This is a prospective comparative study done on 100 patients with chest trauma, either isolated chest trauma or as a part of polytrauma, who presented to the Emergency Department of Menoufia University Hospital during the period from April 2019 to April 2020. TTSS score was applied to assess its performance and comparing it with TRISS score.Results TTSS and TRISS scores were applied on 100 patients with trauma meeting inclusion criteria to predict the hospital mortality in thoracic trauma. The area under the receiver operating characteristics curve was 0.88 for TTSS score and 0.892 for TRISS score.Conclusion This study demonstrates that the TRISS, and the TTSS, can be used to predict hospital mortality in patients with thoracic trauma; hence, additional prospective studies are required. We believe that the study provides important information regarding validation of the TTSS, as it had a direct correlation with need for oxygenation, ventilator, duration of hospital stay, mortality, or outcome in patients with chest trauma. 

Thorax trauma severity score and trauma injury severity score evaluation as outcome predictors in chest trauma

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.

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

Background In blunt chest trauma, patient management is challenging because clinical guidelines miss tools for risk assessment. No clinical scale reliably measures the severity of cases and the chance of complications. Aim The objective of the study was to optimize the management of patients with blunt chest trauma by creating models prognosticating the transfer to the intensive care unit and in-hospital length of stay (LOS). Methods The study cohort consisted of 212 cases. We retrieved information on the cases from the hospital’s trauma registry. After segmenting the lungs with Lung CT Analyzer, we performed volumetric feature extraction with data-characterization algorithms in PyRadiomics. Results To predict whether the patient will require intensive care, we used the three groups of findings: ambulance, admission, and radiomics data. When trained on the ambulance data, the models exhibited a borderline performance. The metrics improved after we retrained the models on a combination of ambulance, laboratory, radiologic, and physical examination data (81.5% vs. 94.4% Sn). Radiomics data were the top-accurate predictors (96.3% Sn). Age, vital signs, anthropometrics, and first aid time were the best-performing features collected by the ambulance service. Laboratory findings, AIS scores for the lower extremity, abdomen, head, and thorax constituted the top-rank predictors received on admission to the hospital. The original first-order kurtosis had the highest predictive value among radiomics data. Top-informative radiomics features were derived from the right hemithorax because the right lung is larger. We constructed regression models that can adequately reflect the in-hospital LOS. When trained on different groups of data, the machine-learning regression models showed similar performance (MAE/ROV <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="IM1"><mml:mo>≈</mml:mo></mml:math> 8%). Anatomic scores for the body parts other than thorax and laboratory markers of hemorrhage had the highest predictive value. Hence, the number of injured body parts correlated with the case severity. Conclusion The study findings can be used to optimize the management of patients with a chest blunt injury as a specific case of monotrauma. The models we built may help physicians to stratify patients by risk of worsening and overcome the limitations of existing tools for risk assessment. High-quality AI models trained on radiomics data demonstrate superior performance. 

Streamlining management in thoracic trauma: radiomics- and AI-based assessment of patient risks

Early patient assessment is relevant for surgical decision making in severely injured patients and early definitive surgery is known to be beneficial in stable patients. The aim of this systematic review is to extract parameters indicative of risk factors for adverse outcome. Moreover, we aim to improve decision making and separate patients who would benefit from early versus staged definitive surgical fixation.Following the PRISMA guidelines, a systematic review of peer-reviewed articles in English or German language published between (2000 and 2022) was performed. The primary outcome was the pathophysiological response to polytrauma including coagulopathy, shock/haemorrhage, hypothermia and soft tissue injury (trauma, brain injury, thoracic and abdominal trauma, and musculoskeletal injury) to determine the treatment strategy associated with the least amount of complications. Articles that had used quantitative parameters to distinguish between stable and unstable patients were summarized. Two authors screened articles and discrepancies were resolved by consensus. Quantitative values for relevant parameters indicative of an unstable polytrauma patient were obtained.The initial systematic search using MeSH criteria yielded 1550 publications deemed relevant to the following topics (coagulopathy (n = 37), haemorrhage/shock (n = 7), hypothermia (n = 11), soft tissue injury (n = 24)). Thresholds for stable, borderline, unstable and in extremis conditions were defined according to the existing literature as follows: Coagulopathy; International Normalized Ratio (INR) and viscoelastic methods (VEM)/Blood/shock; lactate, systolic blood pressure and haemoglobin, hypothermia; thresholds in degrees Celsius/Soft tissue trauma: traumatic brain injury, thoracic and abdominal trauma and musculoskeletal trauma.In this systematic literature review, we summarize publications by focusing on different pathways that stimulate pathophysiological cascades and remote organ damage. We propose that these parameters can be used for clinical decision making within the concept of safe definitive surgery (SDS) in the treatment of severely injured patients. 

How to Clear Polytrauma Patients for Fracture Fixation: Results of a systematic review of the literature.

Chest injury, also known as chest trauma, is any form of physical injury to the chest including the ribs, heart, large vessels of thorax and lungs etc. Chest injuries accounts for 25% of all deaths from injuries due to trauma. Chest injuries are caused by blunt mechanisms, such as motor vehicle collisions, fall from height or penetrating mechanisms such as stab injury, machine injury or gunshot injuries. In 2000, Pape et al described the thoracic trauma severity score (TTSS), a scale that included both anatomical and functional parameters for assessment of severity of chest trauma. TTSS combines the patient’s age, resuscitation parameters and radiological assessment of thorax. TTSS employs 5 specific parameters: rib fractures, lung contusions, PaO2/FiO2 ratio, age, and pleural involvement. These parameters are scored from 0 to 5. The TTSS is calculated by adding the score of each of these five parameters; minimum score is 0 and maximum score is 25. Severity of chest injury is calculated by adding these coding severity points in TTSS. Higher the sum of all ABSTRACT

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A study to validate thoracic trauma severity score in chest trauma patients

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A study to validate thoracic trauma severity score in chest trauma patients