Risk Score for Predicting Mortality in Flail Chest

摘要

AppendixReferencesFlail 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.MethodsA 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.ResultsThe 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.ConclusionsWe 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.Abbreviations and Acronyms: BAC (blood alcohol concentration), CPAP (continuous positive airway pressure), CPR (cardiopulmonary resuscitation), GCS (Glasgow Coma Scale), IPPV (intermittent positive pressure ventilation), ISS (injury severity score), OR (odds ratio), OTR (Ontario Trauma Registry), SAS (statistical analysis system), SD (standard deviation), TRISS (trauma injury severity score)Flail chest is a severe type of rib fracture with an estimated mortality rate of 10% to 36% of cases [