title: Comparison of different thoracic trauma scoring systems in regards to prediction of post-traumatic complications and outcome in blunt chest trauma.
abstract: BACKGROUND
  As accurate assessment of thoracic injury severity in the early phase after trauma is difficult, we compared different thoracic trauma scores regarding their predictive ability for the development of post-traumatic complications and mortality.
  
  
  METHODS
  Two hundred seventy-eight multiple trauma patients (ISS ≥ 16) age > 16 y with severe blunt chest trauma (AIS(chest) ≥ 3) admitted between 2000 and 2009 to Level I Trauma center were included. Exclusion criteria were severe traumatic brain injury (AIS(head) ≥ 3) and penetrating thoracic trauma. The association between AIS(chest), Pulmonary Contusion score (PCS), Wagner-score and Thoracic Trauma Severity score (TTS), and duration of ventilation, length of ICU stay, development of post-traumatic complications, and mortality was investigated. Statistical analysis was performed with χ(2)-test, ANOVA, logistic regression, and receiver operating characteristic (ROC) curve.
  
  
  RESULTS
  Patients' mean age was 42.7 ± 17.0 y, the mean injury severity score was 28.7 ± 9.3 points. Overall, 60 patients (21.6%) developed ARDS, 143 patients (51.4%) SIRS, 110 patients (39.6%) sepsis, and 36 patients (13.0%) MODS. Twenty-two patients (7.9%) died. Among the examined thoracic trauma scores only the TTS was an independent predictor of mortality. With the TTS showing the best prediction power, the TTS, PCS, and Wagner-score were independent predictors of ventilation time, length of ICU stay, and the development of post-traumatic ARDS and MODS.
  
  
  CONCLUSIONS
  Thoracic trauma scores combining anatomical and physiologic parameters like the TTS seem to be most suitable for severity assessment and prediction of outcome in multiple trauma patients with concomitant blunt chest trauma.
authors.affiliation: Trauma Department, Hannover Medical School, Hannover, Germany. mommsen.philipp@mh-hannover.de
authors.forename: Philipp
authors.initials: P
authors.lastname: Mommsen
authors.forename: Christian
authors.initials: C
authors.lastname: Zeckey
authors.forename: Hagen
authors.initials: H
authors.lastname: Andruszkow
authors.forename: Jürgen
authors.initials: J
authors.lastname: Weidemann
authors.forename: Cornelia
authors.initials: C
authors.lastname: Frömke
authors.forename: Patrik
authors.initials: P
authors.lastname: Puljic
authors.forename: Martijn
authors.initials: M
authors.lastname: van Griensven
authors.forename: Michael
authors.initials: M
authors.lastname: Frink
authors.forename: Christian
authors.initials: C
authors.lastname: Krettek
authors.forename: Frank
authors.initials: F
authors.lastname: Hildebrand
mesh_terms: D000328:Adult; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000453:epidemiology; D015995:Prevalence; D011379:Prognosis; D012128:Respiratory Distress Syndrome / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology; D015996:Survival Rate; D018746:Systemic Inflammatory Response Syndrome / Q000453:epidemiology; D013898:Thoracic Injuries / Q000150:complications* / Q000175:diagnosis* / Q000401:mortality; D015599:Trauma Severity Indices; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000175:diagnosis* / Q000401:mortality