Esme H, Solak O, Yurumez Y, Yavuz Y, Terzi Y, Sezer M, Kucuker H
Department of Thoracic Surgery, Afyon Kocatepe University, School of Medicine, Afyon, Turkey.
Thorac Cardiovasc Surg. 2007 Apr;55(3):190-5. doi: 10.1055/s-2006-955883.
Early identification and aggressive management of blunt thoracic trauma are essential to reduce the significant rates of morbidity and mortality. The aim of this study was to evaluate the independent predictive value of 5 different trauma scoring systems (Revised Trauma Score [RTS], Trauma and Injury Severity Score [TRISS], Injury Severity Score [ISS], Lung Injury Scale [LIS], and Chest Wall Injury Scale [CWIS]) with respect to prognostic factors such as tube thoracostomy duration, the need for mechanical support and thoracotomy, the length of hospital and ICU stay, morbid conditions, and deaths of patients with blunt thoracic trauma.
The records of 152 patients with blunt thoracic trauma were reviewed and data consisting of the patients' age and gender, blood pressure and respiratory rate on admission, the extent of chest wall and intrathoracic injury, types of associated injuries, Glasgow Coma Scale (GCS) scores, the need for mechanical support and thoracotomy, tube thoracostomy duration, length of hospital and ICU stay, morbid conditions, and deaths were collected. The relations between the trauma scoring systems and prognostic factors were evaluated by multivariate analysis.
The analysis showed that only TRISS was an independent predictor of mortality and only LIS was an independent predictor of morbidity, the need for thoracotomy, and tube thoracostomy duration. TRISS and LIS were independent predictors of the length of ICU stay. ISS, CWIS, and LIS were independent predictors of the need for mechanical support. RTS, TRISS, ISS and LIS were independent predictors of the length of hospital stay.
The LIS grade appeared to correlate with the severity of blunt thoracic injury and was found to be the most useful scoring system in predicting the outcomes of these patients.
早期识别和积极处理钝性胸部创伤对于降低显著的发病率和死亡率至关重要。本研究的目的是评估5种不同创伤评分系统（修订创伤评分[RTS]、创伤和损伤严重程度评分[TRISS]、损伤严重程度评分[ISS]、肺损伤量表[LIS]和胸壁损伤量表[CWIS]）对于钝性胸部创伤患者的预后因素的独立预测价值，这些预后因素包括胸腔闭式引流持续时间、机械通气支持和开胸手术的需求、住院和重症监护病房（ICU）住院时间、疾病状况以及死亡情况。
回顾了152例钝性胸部创伤患者的记录，收集了患者的年龄、性别、入院时的血压和呼吸频率、胸壁和胸腔内损伤程度、相关损伤类型、格拉斯哥昏迷量表（GCS）评分、机械通气支持和开胸手术的需求、胸腔闭式引流持续时间、住院和ICU住院时间、疾病状况以及死亡情况等数据。通过多变量分析评估创伤评分系统与预后因素之间的关系。
分析表明，只有TRISS是死亡率的独立预测因子，只有LIS是发病率、开胸手术需求和胸腔闭式引流持续时间的独立预测因子。TRISS和LIS是ICU住院时间的独立预测因子。ISS、CWIS和LIS是机械通气支持需求的独立预测因子。RTS、TRISS、ISS和LIS是住院时间的独立预测因子。
LIS分级似乎与钝性胸部损伤的严重程度相关，并且被发现是预测这些患者预后最有用的评分系统。
