title: Risk Score for Predicting Mortality in Flail Chest.
abstract: BACKGROUND
  Flail chest injuries are associated with high mortality and morbidity. Despite evidence that operative repair of flail chest is beneficial, it is rarely done. We sought to create a simple risk score using available preoperative covariates to calculate individual risk of mortality in flail chest.
  
  
  METHODS
  A logistic regression model was trained on Ontario Trauma Registry data to generate a mortality risk score. The final model was validated for calibration and discrimination and corrected for optimism.
  
  
  RESULTS
  The model uses five risk factors that are readily obtained during the initial assessment of the trauma patient: age, Glasgow Coma Score, ventilation, cardiopulmonary resuscitation, and number of comorbidities. It was determined that less than 6 points is consistent with 1% observed mortality, 6 to 10 points predicts 5% mortality, 11 to 15 points predicts 22% mortality, and 16 or more points predicts 46% mortality.
  
  
  CONCLUSIONS
  We have developed a simple model that can be easily applied at bedside to predict mortality in patients with flail chest by accessing a spreadsheet program in an application or other handheld computer device. This model has the potential to be a useful tool for surgeons considering operative repair of flail chest.
authors.affiliation: Department of Epidemiology and Biostatistics, Division of Thoracic Surgery, Western University, London, Ontario, Canada.
authors.forename: Meaghan
authors.initials: M
authors.lastname: Zehr
authors.affiliation: Department of Epidemiology and Biostatistics, Division of Thoracic Surgery, Western University, London, Ontario, Canada.
authors.forename: Neil
authors.initials: N
authors.lastname: Klar
authors.affiliation: Department of Epidemiology and Biostatistics, Division of Thoracic Surgery, Western University, London, Ontario, Canada; Department of Surgery, Division of Thoracic Surgery, Western University, London, Ontario, Canada. Electronic address: richard.malthaner@lhsc.on.ca.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Malthaner
mesh_terms: D005260:Female; D005409:Flail Chest / Q000401:mortality*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D018570:Risk Assessment