Thorax trauma severity score in patient with chest trauma: study at tertiary-level hospital

Thoracic trauma accounts for 20-25% of all trauma-related mortalities and the majority of these deaths occur within few hours of hospitalization. Therefore, prompt diagnosis, assessment of the severity of chest trauma, and immediate treatment are essential to prevent morbidity and mortality. The thorax trauma severity score (TTSS) can be calculated in the emergency room with ease. However, the validity of the TTSS score has still not been evaluated in the Indian setting. This study was conducted with the objective to assess the prognostic role of TTSS to predict the patient's outcome with thoracic trauma.

A prospective observational cross-sectional study was conducted at the Department of Surgery, Shri Vasantrao Naik Government Medical College, Yavatmal, India, from 1st March 2018 to 31st December 2019. A total of 284 patients, primarily admitted for chest trauma, were included in the study. TTSS was used to assess the severity of the trauma; the outcome (non-hospitalized survivors, hospitalized survivors, and hospitalized non-survivors) was recorded along with the patient's data and the scoring system. Patients were grouped as per a TTSS score range. Group I includes patients with a TTSS score of 0-5 points, group II patients with a TTSS score of 6-10, group III patients with a TTSS score of 11-15, group IV patients with a TTTS score of 16-20, and group V patients with a TTSS score of 21-25. Fisher's exact test was used to compare qualitative data. To evaluate the statistical significance of sensitivity and specificity and to choose suitable cut-off points to make decisions, the receiver operator curve (ROC) was used.

The present study included 239 male (84.2%) and 45 female patients (15.8%) with a mean age of 41.57 with a standard deviation of ± 16 years. Sixty-seven (3.9%) patients were non-hospitalized survivors, 202 (71.1%) patients were hospitalized survivors, and 15 (5.3%) patients were hospitalized non-survivors. Two hundred and nineteen (77.1%) patients required conservative management, 49 (17.3%) had unilateral closed thoracostomy, and 11 (3.9%) patients required bilateral thoracostomy. Thoracotomy was required in 3 patients. No mortality was seen in groups I, II, and III. All the 9 patients with TTSS score 21-25 points had fatal prognoses. A TTSS score of 7.5 and above was associated with increased morbidity and mortality in patients with thoracic injuries.

The outcome of thoracic trauma patients can be predicted by using the TTSS. A score of 7.5 and above was associated with morbidity and a score of 20 and above predicted the fatal prognosis.