Laryngotracheal blunt and penetrating traumas: proposal of a novel scoring system and management algorithm

Laryngeal and tracheal traumas (LTT) are rare, life-threatening injuries with heterogeneous presentations and outcomes. While the Schaefer-Fuhrman (SF) classification is widely used to categorize them, its narrative nature may limit the applicability in an emergency setting, especially for penetrating injuries. This study aimed to illustrate a structured descriptive proposal for multi-feature scoring system, suitable for the assessment of both blunt and penetrating LTT.

A retrospective review was conducted on 149 patients with LTT presenting between January 2015 and December 2023 at a single tertiary referral hospital. Patients were categorized using both the SF classification and the novel scoring system. The proposed score is based on the presence and severity of 6 features: edema, hematoma, emphysema, mucosal disruption, vocal fold mobility, and fractures, with an additional point for penetrating trauma. A cut-off score of ≥4 was set to indicate the need for prompt surgical management.

The present cohort consisted of 76.5% blunt and 23.5% penetrating LTT. Based on the SF classification, 6.7% of patients were classified into the surgical groups (Grade III-V), while using the novel scoring system 8.1% of patients scored ≥4. Fisher's exact test confirmed the concordance of the proposed scoring system compared to the SF classification.

This novel, multi-feature scoring system proposes a systematic framework for the initial assessment of LTT. It provides a numerical cut-off to complement clinical decision-making, although future prospective, multicentric validation studies are essential to establish its clinical potential.