title: Traumatic aortic injury score (TRAINS): an easy and simple score for early detection of traumatic aortic injuries in major trauma patients with associated blunt chest trauma.
abstract: OBJECTIVE
  To develop a risk score based on physical examination and chest X-ray findings to rapidly identify major trauma patients at risk of acute traumatic aortic injury (ATAI).
  
  
  METHODS
  A multicenter retrospective study was conducted with 640 major trauma patients with associated blunt chest trauma classified into ATAI (aortic injury) and NATAI (no aortic injury) groups. The score data set included 76 consecutive ATAI and 304 NATAI patients from a single center, whereas the validation data set included 52 consecutive ATAI and 208 NATAI patients from three independent institutions. Bivariate analysis identified variables potentially influencing the presentation of aortic injury. Confirmed variables by logistic regression were assigned a score according to their corresponding beta coefficient which was rounded to the closest integer value (1-4).
  
  
  RESULTS
  Predictors of aortic injury included widened mediastinum, hypotension less than 90 mmHg, long bone fracture, pulmonary contusion, left scapula fracture, hemothorax, and pelvic fracture. Area under receiver operating characteristic curve was 0.96. In the score data set, sensitivity was 93.42 %, specificity 85.85 %, Youden's index 0.79, positive likelihood ratio 6.60, and negative likelihood ratio 0.08. In the validation data set, sensitivity was 92.31 % and specificity 85.1 %.
  
  
  CONCLUSIONS
  Given the relative infrequency of traumatic aortic injury, which often leads to missed or delayed diagnosis, application of our score has the potential to draw necessary clinical attention to the possibility of aortic injury, thus providing the chance of a prompt specific diagnostic and therapeutic management.
authors.affiliation: Department of Cardiac Surgery, Complejo Hospitalario Universitario de A Coruña, As Xubias no 84, 15006, A Coruña, Spain. victor.x.mosquera.rodriguez@sergas.es
authors.forename: Victor X
authors.initials: VX
authors.lastname: Mosquera
authors.forename: Milagros
authors.initials: M
authors.lastname: Marini
authors.forename: Javier
authors.initials: J
authors.lastname: Muñiz
authors.forename: Vanesa
authors.initials: V
authors.lastname: Asorey-Veiga
authors.forename: Belen
authors.initials: B
authors.lastname: Adrio-Nazar
authors.forename: Ricardo
authors.initials: R
authors.lastname: Boix
authors.forename: José M
authors.initials: JM
authors.lastname: Lopez-Perez
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Pradas-Montilla
authors.forename: José J
authors.initials: JJ
authors.lastname: Cuenca
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001011:Aorta / Q000293:injuries*; D001018:Aortic Diseases / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D011237:Predictive Value of Tests; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D013898:Thoracic Injuries / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D013997:Time Factors; D014947:Wounds and Injuries / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000175:diagnosis* / Q000473:pathology