Kim Hongrye, Lee Mou Seop, Yoon Su Young, Han Jonghee, Lee Jin Young, Seok Junepill
Department of Neurosurgery, Chungbuk National University Hospital, Cheongju, Korea.
Department of Thoracic and Cardiovascular Surgery, Chungbuk National University Hospital, Cheongju, Korea.
J Trauma Inj. 2024 Jun;37(2):114-123. doi: 10.20408/jti.2023.0087. Epub 2024 May 9.
Appropriate scoring systems can help classify and treat polytrauma patients. This study aimed to validate chest trauma scoring systems in polytrauma patients.
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.
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).
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.
合适的评分系统有助于对多发伤患者进行分类和治疗。本研究旨在验证多发伤患者胸部创伤评分系统。
分析了1038例多发伤患者的数据。主要结局为一种或多种并发症：肺炎、需要手术的胸部并发症和死亡率。在有或无头部创伤的患者中，使用受试者操作特征（ROC）分析比较了胸部创伤严重程度评分（TTSS）、胸部创伤评分、肋骨骨折评分和RibScore。
总共1038例患者分为两组：有并发症的患者（822例，79.2%）和无并发症的患者（216例，20.8%）。两组之间的性别和体重指数无显著差异。然而，并发症组的年龄更高（64.1±17.5岁对54.9±17.6岁，P<0.001）。并发症组头部创伤患者的比例更高（58.3%对24.6%，P<0.001），格拉斯哥昏迷量表评分更差（中位数[四分位间距]，12[6.5 - 15]对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）、头部创伤组（0.715）和无头部创伤组（0.730）显示出最高的预测价值，而RibScore的表现最差（分别为0.643、0.622和0.622）。
早期损伤严重程度检测和分级对于钝性胸部创伤患者至关重要。迄今为止引入的胸部创伤评分系统，包括TTSS，在临床应用中是不可接受的，尤其是在伴有创伤性脑损伤的多发伤患者中。因此，建议对胸部创伤评分系统进行进一步修订和分析。
