A chest trauma scoring system

to predict outcomes
Jennifer Chen, MD,a Elan Jeremitsky, MD,b Frances Philp, MS,a William Fry, MD,c and
R. Stephen Smith, MD,c Pittsburgh, PA, Lowell, MA, and Columbia, SC

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 1.928.31, P = .001) compared
with those who had CTS < 5.
Conclusion. 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. (Surgery 2014;156:988-94.)
From the Division of Trauma, Surgical Critical Care and Acute Care Surgery, Department of Surgery,a Allegheny
General Hospital, Pittsburgh, PA; Department of General Surgery,b Lowell General Hospital, Lowell, MA; and
Department of Trauma and Critical Care,c University of South Carolina School of Medicine, Columbia, SC

RIB FRACTURES (RIBFX) are a common problem in

blunt trauma, with 10% of injured patients sustaining RIBFX.1 Factors associated with increased
morbidity and mortality from RIBFX are varied
and include age, number of RIBFX, and the development of pneumonia. Pre-existing conditions
such as congestive heart failure and renal and liver
dysfunction have also been found to be associated
with poorer outcomes.2,3 Interventions to implement protocols for elderly trauma victims with
RIBFX reported improved outcomes and
decreased hospital length of stay.4 Several chest
trauma scoring systems have been published to
Presented at the Central Surgical Association 2014 Annual
Meeting in Indianapolis, IN, March 8, 2014.
Accepted for publication June 23, 2014.
Reprint requests: Jennifer Chen, MD, Allegheny General Hospital, 320 E. North Ave., Pittsburgh, PA 15212. E-mail: jchen@
wpahs.org.
0039-6060/$ - see front matter
2014 Elsevier Inc. All rights reserved.
http://dx.doi.org/10.1016/j.surg.2014.06.045

988 SURGERY

identify at risk patients, but these systems have

been evaluated in small volume patient cohorts.5
The rationale for this study is to develop and eventually to use a chest trauma scoring system that is
easy to calculate by a medical provider so medical
decisions and or interventions can be made in an
expedited fashion.
This work uses a RIBFX scoring system that was
previously published by Pressley et al,6 and we
sought to validate that chest trauma scoring system
in a larger dataset. The Chest Trauma Score (CTS)
was derived from several factors identified previously to be associated with worse outcomes,
including age, number of RIBFX, pulmonary contusions, and bilaterality of injury.6 We hypothesized
that a CTS system may be used to predict outcomes
in blunt trauma patients with RIBFX.
METHODS
With institutional review board approval, we used
trauma registry data to identify 1,361 patients with
blunt torso trauma from a single busy Level 1 Trauma
Center during a 3-year period (20092011). A CTS

Chen et al 989

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Volume 156, Number 4

was calculated for each of the individual cohorts.

The CTS is composed of four different components
with a point system assigned: age (<45 years = 1,
4565 = 2, >65 = 3); pulmonary contusion (none = 0,
unilateral minor = 1, bilateral minor = 2, unilateral
major = 3, bilateral major = 4); number of RIBFX
(<3 = 1, 35 = 2, >5 = 3); and the presence of bilateral
RIBFX = 2. The CTS ranges from 2 to 12 (Table I).
Computed tomography (CT) images were reviewed by the authors (W.F. and J.C.) to assign
pulmonary contusion scores and create the individual CTS for each patient in the cohort. Our cohort
was then divided into two groups defined by having
a CTS $ 5, which was similar to the previous study
by Pressley et al6; however, we further delineated
the patient cohort by using different cut points
identified with sensitivity and specificity for the
CTS with the outcomes being evaluated (mortality,
acute pneumonia and respiratory failure). Table II
demonstrates the different cut points for the
different outcome markers by CTS.
Retrospective trauma registry data were collected
for each patient, including: demographics, Injury
Severity Score (ISS), abbreviated injury scale for
chest (AIS chest), duration of stay, and tracheostomy procedure. Hospital complications included
deep-vein thrombosis and pulmonary embolism.
Specific patient outcomes were examined for acute
respiratory failure (ARF), development of pneumonia, and mortality. Definitions for PNX and ARF
are given in the Pennsylvania Trauma Systems
Foundation 2011 manual to standardize capture of
these entities in the registry. The registry codes are
assigned to the definitions to enter these complications into the registry. AIS 98 and 2005 were used to
assess rib fractures and pulmonary contusions.
Specific pulmonary complications, such as
pneumonia and respiratory failure, were chosen
because of the nature of the study involving blunt
chest trauma with RIBFX as these carry substantial
morbidity.
Standard definitions, from the Pennsylvania
Trauma Systems Foundations 2011 Pennsylvania
Trauma Outcomes Study Manual, for these complications were used as follows: Pneumonia required
documentation by physical examination of chest
pathology as well as presence of sputum, sepsis, or
culture. Radiographic documentation of a pulmonary infiltrate or consolidation, and a positive
sputum culture was also used to define the presence
of pneumonia. ARF was defined as need for ventilator support after a period (>48 hours) of nonassisted breathing or requirement for reintubation.
Univariate analysis was conducted using 2 sample
t test or Wilcoxon rank sum test for continuous

Table I. Chest scoring system

Age score
<45 y
4565 y
>65 y
Pulmonary contusion score
None
Unilateral minor
Bilateral minor
Unilateral major
Bilateral major
Rib score
<3 RIBFX
35 RIBFX
>5 RIBFX
Bilateral RIBFX
No
Yes

1
2
3
0
1
2
3
4
1
2
3
0
2

RIBFX, Rib fracture.

variables based on the distribution and chi-square

analysis was used for categorical variables. KaplanMeier survival analysis and multivariable logistic analysis were performed to determine the association of
CTS with mortality, pneumonia, and ARF as separate
outcomes. Receiver operating characteristics
(ROCs) were used to compare the ISS and CTS for
the different outcomes. All tests were two-sided. Stata
SE 12 (College Station, TX) was used for analysis.
RESULTS
Overall mortality for the cohort of 1,361 patients
was 5.4%. Table III illustrates the % mortality by
CTS. Compared with patients who had a CTS < 5,
patients with a CTS $ 5 were older (61.6 vs 50.1),
had greater mortality (9.0 vs 2.2%), greater rate of
hospital complications (ie, pneumonia, ARF), tracheostomy, and greater duration of stay (Table IV).
Figure 1 illustrates the Kaplan Meier survival
curve for patients with CTS $ 5 and < 5 over the
course of hospitalization. A CTS $ 5 was associated
with greater mortality (P < .001, test for equality by
log rank). ROC curves (Figs 2, 3, and 4) were calculated for the different outcomes separately (mortality, pneumonia, and ARF). Compared with ISS, the
CTS appeared to have leas area under the curve
for mortality and pneumonia but greater area under
the curve for ARF. All three separate outcomes by
ISS and CTS, however, were not different by ROC
test of equality. When multivariable logistic regression was used, CTS $ 5 continued to be an important independent predictor for all three outcomes
separately (mortality, pneumonia, and ARF). In
contrast, ISS and AIS chest lacked significance for
the three outcomes in some of the multivariable
regression models (Tables V, VI, and VII).

990 Chen et al

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October 2014

Table II. Sensitivity/specificity ROCs for chest trauma score (n = 1,361)

Mortality
Cutpoint
$2
$3
$4
$5
$6
$7
$8
$9
$10
$11
$12
ROC

Sensitivity %

Pneumonia

Specificity %

Sensitivity %

100
0
95.9
10.1
93.2
29.4
78.1*
55.0*
56.2
74.8
36.0
85.7
23.3
92.4
9.6
96.7
2.7
98.2
1.4
99.3
0
99.8
0.71 (CI 0.650.77)

Acute respiratory failure

Specificity %

Sensitivity %

100
0
95.5
10.1
86.5
29.2
71.9
55.0
43.8
74.3
28.1
85.4
15.7
92.1
9.0
96.7
6.7
98.4
0
99.2
0
99.8
0.65 (CI 0.590.70)

Specificity %

100
0
100
10.1
94.7
28.8
79.0
54.1
55.3
73.9
36.8
85.1
23.7
92.0
5.3
96.4
5.3
98.2
0
99.2
0
99.9
0.72 (CI 0.640.79)

*Statistical significance.
CI, Confidence interval; ROC, receiver operating characteristic.

Table III. Mortality by Chest Trauma Score* (total n = 1,361, with 73 mortality or 5.4%)
Mortality, %
No. patients

10

11

12

2.3
133

0.8
250

3.2
341

5.9
271

9.0
155

10.4
96

15.4
65

20.8
24

6.3
15

12.5
7

0
2

*P < .001.

Table IV. Clinical characteristics of patients by CTS cutpoint

Age, y, mean SD
Mortality, %
ISS, mean SD
Pneumonia, %
Pulmonary embolus, %
Deep-vein thrombosis, %
Acute respiratory failure, %
ICU admission, %
Abdominal trauma, %
ICU duration of stay (median)
Hospital duration of stay (median)
AIS chest (median)
Tracheostomy (n = 68), %

CTS < 5 (n = 724)

CTS $ 5 (n = 637)

P value

50.1 18.6
2.2
16.2 9.6
3.5
1.4
1.4
1.1
46.4
26.7
3 IQR (16)
4 IQR (28)
3 IQR (23)
2.9

61.6 19.2
9.0
21.6 10.2
10.1
2.5
1.7
4.7
69.5
27.2
4 IQR (211)
7 IQR (413)
3 IQR (34)
7.4

<.001
<.001
<.001
<.001
NS
NS
<.001
<.001
.043
<.001
<.001
<.001
<.001

AIS, Abbreviated injury scale; CTS, Chest Trauma Score; ICU, intensive care unit; IQR, interquartile range; ISS, Injury Severity Score; NS, not significant.

DISCUSSION
There is no standardized method to assess the
severity of blunt chest trauma immediately after
the traumatic event. Therefore, there is an unmet
need for a simple scoring system to help categorize
patients into greater-risk groups. Pape et al7 found
that bilateral chest injury, lung contusions, and
number of RIBFX were associated with poor outcomes. They created a thoracic trauma severity
score using several patient variables and found
the thoracic trauma severity score was better at

predicting complications compared to ISS and

AIS chest alone. Although this article was published more than a decade ago, it illustrates the
importance of developing a system to triage
patients.
Clinical pathways also have been developed to
expedite the most appropriate treatment for patients with blunt torso trauma. Todd et al8 evaluated trauma patients with age greater than
45 years with four or more RIBFX; they found
that patients who were enrolled in an aggressive

Surgery
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Fig 1. Survival analysis by Chest Trauma Score (CTS).

P < .001.

Fig 2. Receiver operating characteristic (ROC)-derived

mortality. CTS, Chest Trauma Score; ISS, Injury Severity
Score.

clinical pathway had better outcomes, including

decreased duration of stay, pneumonia, and mortality compared with historic control patients.
Their study suggested a benefit to accurate early
identification of patients with chest trauma to
improve outcomes.
Bergeron et al9 found that patients older than
65 with three or more RIBFX had much greater
mortality. Bulger et al10 found that older patients
compared to younger patients with similar
numbers of RIBFX had more complications,
including pneumonia and mortality.
It is apparent from these studies that both age
and the number of RIBFX are important risk factors
that may be used to predict outcomes. Pressley et al6
created the RIBFX scoring system we used and
modified. They found that patients with CTS $ 7
were associated with greater duration of stay and
ventilator days and greater mortality. Using this

Chen et al 991

Fig 3. Receiver operating characteristic (ROC)-derived

pneumonia. CTS, Chest Trauma Score; ISS, Injury
Severity Score.

Fig 4. Receiver operating characteristic (ROC)-derived

acute respiratory failure. CTS, Chest Trauma Score; ISS,
Injury Severity Score.

RIBFX scoring system but with a different CTS cutpoint ($5) based on ROC, we corroborated their
findings with similar predictors for mortality and
morbidity in a larger data set. By using CTS cutpoints defined by ROC, we were able to validate
their scoring system and incorporate the CTS $ 5
into the data analysis, as well as to simplify the coding by using one score to identify patients at risk
rather than have several different scores.
We compared the CTS with ISS by ROC analysis.
The ISS, although comprehensive, does, however,
appear to have substantial limitations. Because no
other general marker exists for injuries over the
course of the hospitalization, ISS was used in the
analysis and compared with CTS. The CTS was not
different from ISS in the outcomes studied by ROC
analysis. AIS chest and ISS were not predictors in
all the multivariable models, but the CTS was

992 Chen et al

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October 2014

Table V. Logistic regression multivariable analysis

for mortality and chest trauma
Odd
ratio
Chest Trauma
Score $5*
Injury Severity Score
AIS chest
Duration of stay
Pneumonia
Pulmonary embolus
Deep-vein thrombosis
Acute respiratory
failure
Tracheostomy
Abdominal trauma

P value

95% confidence
interval

3.99y

<.001y

1.928.31y

1.12
0.67
0.91
3.91
4.58
0.49
3.44

<.001
.043
<.001
.006
.058
.60
.055

1.091.15
0.450.99
0.860.96
1.4710.38
0.9522.01
0.037.14
0.9712.22

0.42
1.99

.27
.026

0.0901.96
1.093.67

Table VII. Logistic regression multivariable

analysis for acute respiratory failure and chest
trauma
Odd ratio
Chest Trauma
Score $5*
Injury Severity Score
AIS chest
Duration of stay
Pneumonia
Pulmonary embolus
Deep-vein thrombosis
Mortality
Tracheostomy
Abdominal trauma

4.43y
1.01
0.79
1.04
6.95
2.04
7.46
2.11
0.67
1.02

P value
.004y
.57
.35
.001
<.001
.30
.003
.20
.48
.96

Confidence
interval
1.6312.07y
0.971.05
0.471.30
1.021.08
3.0216.04
0.527.92
2.0327.48
0.686.60
0.222.06
0.462.26

*Referent: Chest Trauma Score <5.

yStatistical significance.
AIS, Abbreviated injury scale.

*Referent: Chest Trauma Score <5.

yStatistical significance.
AIS, Abbreviated injury scale.

Table VI. Logistic regression multivariable analysis

for pneumonia and chest trauma

There are many limitations to this study. We did

not assess the impact of subsequent therapeutic
interventions on outcomes. Injured patients were
managed by a mature trauma program that
decreased variation in care through the use of
standard management protocols. The ability of the
CTS to predict outcomes is clearly limited. The
ROC for CTS and mortality is 0.71. The CTS was
weighted purposely toward greater sensitivity at the
expense of specificity. This permitted the detection
of more negative outcomes (mortality, and
morbidity), but increased the number of falsepositive results. It was not possible in this retrospective study to control for patients who had care
withdrawn rather than face a futile ICU course.
This clearly impacts duration of stay and tracheostomy as outcome variables because mortality
occurred earlier in the hospital course of for
some of these patients, while survivors were more
likely to undergo a tracheostomy. We used CT to
assess blunt chest trauma, whereas in previously
published papers investigators primarily used chest
x-rays. CT is more sensitive in detecting injuries,
especially pulmonary contusions.
It is also apparent that when Table III is evaluated
further, even though the cohorts are fairly equal in
patient size, when divided by a CTS score of 5, it is
still somewhat skewed toward the lesser scores
greater than 5. There were only two patients in the
CTS 12 group, and because of the low number of patients, none had actually died. This also explains why
the greatest scores had at times discordant mortality
rates, and, of note, our overall mortality was 5%.
Because of the heterogeneous characteristics of
our trauma population with patients who present

Odd ratio
Chest Trauma
Score $5*
Injury Severity Score
AIS chest
Duration of stay
Mortality
Pulmonary embolus
Deep-vein thrombosis
Acute respiratory
failure
Tracheostomy
Abdominal trauma

2.04y

P value

Confidence
interval

0.021y

1.113.74y

1.03
0.94
1.07
2.11
0.59
0.69
5.53

0.014
0.74
<0.001
0.095
0.51
0.62
<0.001

2.36
1.21

0.027
0.50

1.001.06
0.671.32
1.051.10
0.885.05
0.132.79
0.163.04
2.4512.47
1.105.05
0.702.08

*Referent: Chest Trauma Score <5.

yStatistical significance.
AIS, Abbreviated injury scale.

predictive. The CTS provides an expedited way

identify patients at risk of morbidity and mortality
from RIBFX which the ISS and AIS chest are
unable to duplicate. ISS is also a score that is
calculated after discharge and all the charts have
been abstracted ISS is not readily available on
admission, whereas the CTS is easily calculated.
Although it is beyond the scope of this study to
address all the potential ramifications and clinical
implications of using the CTS in daily practice, the
CTS clearly allows early identification of patients
that are at high risk for complications so that they
may be considered for early interventions such as
epidural analgesia or operative management for
stabilization of the RIBFX.

Surgery
Volume 156, Number 4

with polytrauma and multiple comorbidities, CTS

is not able to identify every outcome. In addition,
because of the nature of trauma management,
patients are usually overtriaged in an effort to
avoid missed injuries, and thus, the CTS was
developed to gear toward greater sensitivity at the
expense of specificity to avoid patients who may
potentially have worse outcomes.
The CTS is an easy and quick method to assess
the relative severity of blunt chest injury in a
patient. Although no single scoring system is
perfectly predictive of outcomes, the CTS provides
a method to categorize chest wall injury and
potentially intervene earlier in the hospital course
of individual patients.
The authors thank Amy H. Kao MD, MPH, MS, for her
invaluable assistance in editing the manuscript.

REFERENCES
1. Brown SD, Walters MR. Patients with rib fractures. J Trauma
Nurs 2012;19:89-91.
2. Battle CE, Hutchings H, Evans PA. Risk factors that predict
mortality in patients with blunt chest wall trauma: a systematic review and meta-analysis. Injury 2012;43:8-17.
3. Brasel KJ, Guse CE, Layde P, et al. Rib fractures: relationship with pneumonia and mortality. Crit Care Med 2006;
34:6.
4. Sahr SH, Webb ML, Hackett Renner C, et al. Implementation of a rib fracture triage protocol in elderly trauma patients. J Trauma Nurs 2013;20:172-5.
5. Maxwell CA, Mion LC, Dietrich MS. Hospitalized injured
older adults. J Trauma Nurs 2012;19:168-74.
6. Pressley CM, Fry WR, Philp AS, et al. Predicting outcome of
patients with chest wall injury. Am J Surg 2012;204:910-4.
7. Pape HC, Remmers D, Rice J, et al. Apprasial of early evaluation of blunt chest trauma: Development of a standardized scoring system for initial clinical decision making.
J Trauma 2000;49:496-504.
8. Todd SR, McNally MM, Holcomb JB, et al. A multidisciplinary clinical pathway decreases rib fracture-associated
infectious morbidity and mortality in high-risk trauma patients. Am J Surg 2006;192:806-11.
9. Bergeron E, Lavoie A, Clas D, et al. Elderly trauma patients
with rib fractures are at greater risk of death and pneumonia. J Trauma 2003;54:3.
10. Bulger E, Arneson MA, Mock CN, et al. Rib fractures in the
elderly. J Trauma 2000;48:1040-6.

DISCUSSION
Dr Brian Harbrecht (Louisville, KY): As Dr Chen
mentioned, this is a follow-up study to a previous
publication looking at the scoring system, with
many of the same coauthors from that institution.
I agree completely with your conclusion that people who have bad chest trauma are going to do
worse. Im always humbled in terms of trying to
predict who exactly is going to do better and
worse. Some patients with one RIBFX are in

Chen et al 993

excruciating agony, and some patients with five

dont seem to turn a hair; however, this particular
scoring system may help.
A couple of questions: one, because many of the
authors are the same and the institution is the
same, are these patients the same as that earlier
data set? Because if they are, that kind of calls into
question whether you should be validating your
scoring system with the same patients that you used
to develop the scoring system.
The other is that when you are dealing with
some subjective variables, the definitions of those
variables are key. Pulmonary contusion is a very
challenging thing to quantify. Was there a standard
definition for applying the grading score for pulmonary contusion? Was this performed radiographically? Was this performed off the radiology
report? Was it performed by the same individual?
What was the standardization for that?
Similarly for pneumonia: as you know, in many
trauma patients, pneumonia can be a very challenging diagnosis. Was this simply pulled from the
registry based on registrar coding, or was this
reviewed by the physicians? If it was registrar
coding, did the registrars use standard definitions?
Was there a quality control to make sure that they
were really coding pneumonia correctly, or did
they just pull a pneumonia diagnosis because the
fourth-year medical student said they might have
pneumonia in the medical record?
The other question hinges on mortality, which is
obviously a very important end point. In your
mortality analysis, did you exclude people whose
death would be unlikely to be contributed to by
the blunt chest trauma, people who died of
exsanguinating hemorrhage, people who had severe traumatic brain injuries? Or did you just
simply quantify all-cause mortality?
Dr Jennifer Chen: In terms of your questions,
are the patients from the same data set? They are
not. They are actually analyzed from two different
institutions. The first study looked at about 600
patients at a separate institution, and our study
had about 1,300 patients. So they were entirely
different patient populations.
In terms of defining pulmonary contusions, it
was done radiographically. We looked at CT scans
by two separate surgeons. Our definition of the
pulmonary contusion was based off of the AIS
chest coding system. And so for minor pulmonary
contusions, we quantified that as being involved in
less than one lobe. If it was a major pulmonary
contusion, it was greater than one lobe. So, yes, yes
could say there is some subjectiveness because it is
based off two surgeons, not the radiologist.

994 Chen et al

In terms of how pneumonia was found, it was

pulled from the trauma registry. And it was based
off of coding. And there was no way to tell whether
the coders were coding it accurately or if they were
being pulled randomly from the chart because a
medical student had written it.
And in terms of any exclusion for mortality,
from the way that our study was conducted, we did
not have a chance to exclude all of our mortality.
We did exclude some who showed up in our
trauma bay and quickly died and for whom we
didnt have a chance to get a CT scan. Otherwise,
however, we didnt exclude those who died for
other reasons, such as brain trauma.
Dr Jason Smith (Louisville, KY): My question is
that you included age as part of your scoring
criteria. Are we simply seeing a reproduction of
older patients with a greater score having greater
morbidity and mortality related to chest trauma?
When you look at your scoring, in the patients
where age was not a predominant factor in that
chest score, did you still have the similar findings
that you did based on what you presented?
Dr Jennifer Chen: When we looked at our four
factors in our chest trauma scoring system, we
found that age and number of RIBFX were the
most significant factors. Did we look to see separately if age was a factor? We didnt do that.
Dr Martin Zielinski (Rochester, MN): The American Association for the Surgery of Trauma scoring
system developed back in the early 1990s and the
AIS are terrible at predicting who needs rib fracture fixation. I didnt see any data up there if any
of your patients did get it. Is this a scoring system
that could potentially be applied to predict who
needs it?
Dr Jennifer Chen: We didnt look to see in this
study whether these patients ultimately required
operative fixation, but, yes, it is something that we

Surgery
October 2014

would like to look into and see whether patients

with a greater score would benefit from fixation.
Dr Tim Hayward (Indianapolis, IN): Are you using the Trauma Quality Improvement Program at
your trauma center? Because using that and looking at the probability of survival that those things
calculate, the standard definitions, the training
that your trauma registrars have to be put through
on a monthly basis, dramatically improve the data
in ones model to predict these things and would
eliminate some of these people who werent going
to survive from their other injuries and give you a
much more accurate presentation.
Dr Frederick Luchette (Maywood, IL): Several
years ago, we actually presented a paper here using
the National Trauma Data Bank. We validated that
with each successive RIBFX and chest trauma,
theres a significant increase in mortality. The
break point from one to five was 5% mortality at
one RIBFX up to approximately 10% at five.
When you get above five, the mortality went
through the ceiling that when you got to eight, it
was 30%, 40%. We did also report that age was
an independent predictor of outcome.
What also occurs, as you know, with each
successive RIBFX, theres an increased incidence,
statistically significant, of associated injuries, pneumothorax, hemothorax, pulmonary contusion.
My question to you is quite simple. What do I do
with the CTS when I go home? How do I use that
in my management of the patients?
Dr Jennifer Chen: I would like to think that with
our CTS, it would bring more vigilance to those patients who are at risk. I would like to think that for
our institution, knowing that the patients have a
greater CTS, we would be more apt to having
them stay in the intensive care unit for vigilance
and for early adaptation of epidural catheters for
pain relief.