Division of Trauma, Surgical Critical Care and Acute Care Surgery, Department of Surgery, Allegheny General Hospital, Pittsburgh, PA.
Department of General Surgery, Lowell General Hospital, Lowell, MA.
Surgery. 2014 Oct;156(4):988-93. doi: 10.1016/j.surg.2014.06.045.
Rib fractures (RIBFX) are a common injury and are associated with substantial morbidity and mortality. Using a previously published RIBFX scoring system, we sought to validate the system by applying it to a larger patient population. We hypothesized that the RIBFX scoring system reliably predicts morbidity and mortality in patients with chest wall injury at the time of initial evaluation.
A 3-year, registry-based, retrospective study involving 1,361 trauma patients was performed. Patients were divided into two groups with a Chest Trauma Score (CTS) < 5 and ≥5 (n = 724 and 637, respectively). Each cohort was analyzed for specific outcomes (mortality, pneumonia, acute respiratory failure). CTS was defined by age, severity of pulmonary contusion, number of RIBFX, and the presence of bilateral RIBFX with a maximum score of 12. Receiver operating characteristics were used to determine the use of CTS ≥5 cut point.
Patients with a CTS of 5 or more were (P ≤ .05) older (61 vs 50 years), had greater Injury Severity Scores (21.6 vs 16.2), and had a greater prevalence of pneumonia (10.1 vs 3.5%), tracheostomy (7.4 vs 2.9%), and mortality (9.0 vs 2.2%). Patients with CTS ≥ 5 had nearly 4-fold increased odds of mortality (odds ratio 3.99, 95% confidence interval 1.92-8.31, P = .001) compared with those who had CTS < 5.
A CTS of at least 5 is associated with worse patient outcomes. Increased vigilance is needed with trauma patients who present with RIBFX and a CTS ≥ 5 at initial presentation. This simple RIBFX scoring system may improve early identification of vulnerable patients and expedite therapeutic interventions.
肋骨骨折（RIBFX）是一种常见的损伤，与大量发病率和死亡率相关。使用先前发表的 RIBFX 评分系统，我们试图通过将其应用于更大的患者群体来验证该系统。我们假设 RIBFX 评分系统在初始评估时可靠地预测胸壁损伤患者的发病率和死亡率。
进行了一项为期 3 年的基于登记的回顾性研究，涉及 1361 名创伤患者。患者分为胸外伤评分（CTS）<5 和≥5 两组（n=724 和 637）。分析每个队列的特定结局（死亡率、肺炎、急性呼吸衰竭）。CTS 通过年龄、肺挫伤严重程度、肋骨骨折数量和双侧肋骨骨折的存在来定义，最高得分为 12 分。使用接收者操作特征来确定 CTS≥5 切点的使用。
CTS 为 5 或更高的患者（P≤0.05）年龄更大（61 岁 vs 50 岁），损伤严重程度评分更高（21.6 分 vs 16.2 分），肺炎（10.1% vs 3.5%）、气管切开术（7.4% vs 2.9%）和死亡率（9.0% vs 2.2%）的发生率更高。与 CTS<5 的患者相比，CTS≥5 的患者死亡率的可能性几乎增加了 4 倍（比值比 3.99，95%置信区间 1.92-8.31，P=0.001）。
CTS 至少为 5 与患者结局较差相关。对于初始表现为 RIBFX 和 CTS≥5 的创伤患者，需要提高警惕。这种简单的 RIBFX 评分系统可能有助于早期识别脆弱患者并加快治疗干预。
