title: Predicting outcomes after blunt chest wall trauma: development and external validation of a new prognostic model.
abstract: BACKGROUND
  Blunt chest wall trauma accounts for over 15% of all trauma admissions to Emergency Departments worldwide. Reported mortality rates vary between 4 and 60%. Management of this patient group is challenging as a result of the delayed on-set of complications. The aim of this study was to develop and validate a prognostic model that can be used to assist in the management of blunt chest wall trauma.
  
  
  METHODS
  There were two distinct phases to the overall study; the development and the validation phases. In the first study phase, the prognostic model was developed through the retrospective analysis of all blunt chest wall trauma patients (n = 274) presenting to the Emergency Department of a regional trauma centre in Wales (2009 to 2011). Multivariable logistic regression was used to develop the model and identify the significant predictors for the development of complications. The model's accuracy and predictive capabilities were assessed. In the second study phase, external validation of the model was completed in a multi-centre prospective study (n = 237) in 2012. The model's accuracy and predictive capabilities were re-assessed for the validation sample. A risk score was developed for use in the clinical setting.
  
  
  RESULTS
  Significant predictors of the development of complications were age, number of rib fractures, chronic lung disease, use of pre-injury anticoagulants and oxygen saturation levels. The final model demonstrated an excellent c-index of 0.96 (95% confidence intervals: 0.93 to 0.98).
  
  
  CONCLUSIONS
  In our two phase study, we have developed and validated a prognostic model that can be used to assist in the management of blunt chest wall trauma patients. The final risk score provides the clinician with the probability of the development of complications for each individual patient.
authors.forename: Ceri
authors.initials: C
authors.lastname: Battle
authors.forename: Hayley
authors.initials: H
authors.lastname: Hutchings
authors.forename: Simon
authors.initials: S
authors.lastname: Lovett
authors.forename: Omar
authors.initials: O
authors.lastname: Bouamra
authors.forename: Sally
authors.initials: S
authors.lastname: Jones
authors.forename: Aruni
authors.initials: A
authors.lastname: Sen
authors.forename: James
authors.initials: J
authors.lastname: Gagg
authors.forename: David
authors.initials: D
authors.lastname: Robinson
authors.forename: Jake
authors.initials: J
authors.lastname: Hartford-Beynon
authors.forename: Jeremy
authors.initials: J
authors.lastname: Williams
authors.forename: Adrian
authors.initials: A
authors.lastname: Evans
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D013898:Thoracic Injuries / Q000175:diagnosis* / Q000628:therapy; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000628:therapy