title: A chest trauma scoring system to predict outcomes.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Trauma, Surgical Critical Care and Acute Care Surgery, Department of Surgery, Allegheny General Hospital, Pittsburgh, PA. Electronic address: jchen@wpahs.org.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of General Surgery, Lowell General Hospital, Lowell, MA.
authors.forename: Elan
authors.initials: E
authors.lastname: Jeremitsky
authors.affiliation: Division of Trauma, Surgical Critical Care and Acute Care Surgery, Department of Surgery, Allegheny General Hospital, Pittsburgh, PA.
authors.forename: Frances
authors.initials: F
authors.lastname: Philp
authors.affiliation: Department of Trauma and Critical Care, University of South Carolina School of Medicine, Columbia, SC.
authors.forename: William
authors.initials: W
authors.lastname: Fry
authors.affiliation: Department of Trauma and Critical Care, University of South Carolina School of Medicine, Columbia, SC.
authors.forename: R Stephen
authors.initials: RS
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D012042:Registries; D012189:Retrospective Studies; D012253:Rib Fractures / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D015599:Trauma Severity Indices