Modified Pain, Inspiratory Capacity, and Cough (PIC) Score: An Easy Alternative Triage Tool in Blunt Thoracic Trauma

BackgroundThe severity of injury in patients with rib fractures has historically been underestimated at the time of presentation, making early identification of high-risk patients essential for optimal care. The Pain, Inspiratory Capacity, and Cough (PIC) scoring system was developed to assess rib fracture severity, incorporating pain, inspiratory capacity, and cough strength. However, the original PIC score is cumbersome to obtain at the bedside. We used a modified PIC score by simplifying the inspiratory capacity assessment with fixed inspiratory volume thresholds (1500 mL and 750 mL). This study aimed to determine if our modified PIC score is an appropriate substitute for the original PIC score to determine the need for intensive care unit (ICU) level of care and/or predict adverse outcomes.MethodsThis is a retrospective cohort study at a level 1 trauma center. All adults who sustained rib fractures from January 2019 to December 2020 were identified using the local trauma registry. The electronic medical record was queried for standard demographics, admission modified PIC score, ICU admission, ICU length of stay (LOS), complications, and mortality. The original PIC score was then calculated among these same patients and compared.ResultsThe results showed high concordance (≥89.6%) between the original and modified scores. Importantly, using the modified score reduced ICU admissions by 22.4%, without missing any patients requiring intensive care.DiscussionThe modified PIC score demonstrated equivalent prognostic value while being easier to use, offering a practical tool for guiding ICU triage decisions.