Thoracic Trauma Severity score on admission allows to determine the risk of delayed ARDS in trauma patients with pulmonary contusion |
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| Affiliation: | 1. Trauma Intensive and Critical Care Unit, Lapeyronie University Hospital, Montpellier, France;2. Department of Radiology, Lapeyronie University Hospital, Montpellier, France;3. Intensive Care Unit and Transplantation, Critical Care and Anesthesia Department (DAR B), Saint-Éloi University Hospital, Montpellier, France;4. Institut National de la Santé et de la Recherche Médicale, Inserm U1046, Montpellier, France;1. Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Foundation, United States;2. Bureau of Sciences Services, Wisconsin Department of Natural Resources, United States;3. National Farm Medicine Center, Marshfield Clinic Research Foundation, United States;1. Department of Trauma Research, Medical Center of Plano, 3901 West 15th Street, Plano, TX 75075, United States;2. Department of Trauma Research, Swedish Medical Center, 501 E. Hampden Ave, Englewood, CO 80113, United States;3. Department of Trauma Research, St. Anthony Hospital, 11600 W. 2nd Place, Lakewood, CO 80228, United States;4. Trauma Services Department, Medical Center of Plano, 3901 W. 15th St, Plano, TX 75075, United States;5. Trauma Services Department, St. Anthony Hospital, 11600 West 2nd Place, Lakewood, CO 80228, United States;7. Trauma Services Department, Swedish Medical Center, 499 E. Hampden Ave, Englewood, CO 80113, United States;6. Trauma Services Department, Intermountain Neurosurgery, 11700 W. 2nd Place, Lakewood, CO 80228, United States;8. Trauma Services Department, Rocky Vista University, 8401 S. Chambers Rd, Parker, CO 80134, United States;1. Department of Surgery, University of Washington, Seattle, WA, USA;2. School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana;3. Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana;4. Department of Community Medicine, Al Munstansiriya University, Baghdad, Iraq;5. Human Resources Development and Training Center, Iraq Ministry of Health, Baghdad, Iraq;6. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA;7. Department of Global Health, University of Washington, Seattle, WA, USA;8. Institute for Health Metrics and Evaluation, Seattle, WA, USA;9. Department of Health Services, University of Washington, Seattle, WA, USA;10. Department of International Health, Center for Refugee and Disaster Response, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA;11. Surgeons OverSeas (SOS), New York, NY, USA;12. Department of Surgery, Columbia University, New York, NY, USA;13. Department of Interdisciplinary Health Sciences, Stellenbosch University, Cape Town, South Africa;1. Department of Surgery, Kern Medical Center, USA;2. Department of Radiology, Kern Medical Center, USA;1. Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States;2. Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States;3. The Leonard Davis Institute, Wharton School of Business at the University of Pennsylvania, Philadelphia, PA, United States;4. Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States;5. Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States;6. Department of Emergency Medicine, Jefferson University School of Philadelphia Medicine, PA, United States |
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| Abstract: | BackgroundPulmonary contusion is a major risk factor of acute respiratory distress syndrome (ARDS) in trauma patients. As this complication may appear after a free interval of 24–48 h, detection of patients at risk is essential. The main objective of this study was to assess the performance of the Thoracic Trauma Severity (TTS) score upon admission in predicting delayed ARDS in blunt trauma patients with pulmonary contusion.MethodsAll blunt thoracic trauma patients admitted consecutively to our trauma centre between January 2005 and December 2009 were retrospectively included if they presented a pulmonary contusion on the admission chest computed tomography scan. Main outcome measure was the presence of moderate or severe ARDS (PaO2/FiO2 ratio ≤ 200) for 48 h or more. The global ability of the TTS score to predict ARDS was studied by ROC curves with a threshold analysis using a grey zone approach.ResultsOf 329 patients studied (75% men, mean age 36.9 years [SD 17.8 years], mean Injury Severity Score 21.7 [SD 16.0]), 82 (25%) presented with ARDS (mean lowest PaO2/FiO2 ratio of 131 [SD 34]). The area under the ROC curves for the TTS score in predicting ARDS was 0.82 (95% CI 0.78–0.86) in the overall population. TTS scores between 8 and 12 belonged to the inconclusive grey zone. A TTS score of 13–25 was found to be independent risk factors of ARDS (OR 25.8 [95% CI 6.7–99.6] P < 0.001).ConclusionsAn extreme TTS score on admission accurately predicts the occurrence of delayed ARDS in blunt thoracic trauma patients affected by pulmonary contusion. This simple score could guide early decision making and management for a non-negligible proportion of this specific population. |
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| Keywords: | Thoracic Trauma Severity score Pulmonary contusion Acute respiratory distress syndrome Berlin definition |
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