Role of the Chest Trauma Scoring System as a Predictor of Mortality and Morbidity and as a Prognostic Tool in Thoracic Trauma Patients: A Prospective Observational Study

Background and Aims: Prognostication of patients with chest trauma using scoring systems is an effective tool for predicting the morbidity and mortality. This study aimed to assess the predictive and prognostic values of the chest trauma scoring (CTS) system in patients with thoracic trauma. Methods: This prospective observational study was conducted at the Department of General Surgery and Emergency Medicine of a tertiary care teaching hospital. The CTS was calculated using age, pulmonary contusion severity, number of rib fractures, and the presence of bilateral rib fractures. The final CTS range is 2–12. The objective of the present study was to determine the predictive ability of the CTS for morbidity, mortality, and prognostication in patients with thoracic trauma. Results and Discussion: Data were collected for 185 patients. High CTS ≥ 5 was statistically significantly associated with the need for intensive care unit admission, need for inter-coastal drainage insertion, and development of complications (pneumonia, acute respiratory distress syndrome (ARDS), and metabolic complications) and increased the requirement for mechanical ventilation. Patients with CTS ≥5 had significantly higher complication rates: pneumonia (38.2% vs. 2.1%, P < 0.001), ARDS (7.9% vs. 1.0%, P < 0.05), and metabolic complications (10.1% vs. 1.0%, P < 0.05). The overall mortality was 3.8%, with CTS≥ 7 associated with 17.1% mortality compared to 0.7% in CTS <7 patients ( P < 0.001). The CTS demonstrated good predictive performance with a sensitivity/specificity of 83.3%/85.3% for morbidity and 85.7%/83.7% for mortality. Conclusion: This study concludes that a CTS score of 5 or higher is significantly associated with increased morbidity, and a CTS score of 7 or higher is associated with increased mortality. The CTS demonstrated good predictive performance in identifying patients who are likely to develop complications. The CTS can be a useful tool in predicting morbidity, mortality, and prognostication in patients with thoracic trauma and institute early intensive care.