Determining the cutoff for thoracic trauma severity score for predicting the outcome following blunt thoracic trauma in an Indian population presenting to a level 1 trauma centre

Introduction: In 2000, Pape and colleagues designed the Thorax Trauma Severity Score (TTSS) that integrated the anatomical and physiological parameters to predict the outcome following trauma to chest. Given the wide variability in the cut-off level for predicting outcome, we intended to analyze the cut-off and study the sensitivity and specificity of TTSS in our population in predicting the mortality. We also aimed to quantify the utility of TTSS at presentation in predicting the need for ICU care, and need for mechanical ventilation. Methodology: A prospective cohort study was conducted on 300 blunt chest trauma patients presenting to Emergency Department of our level 1 Trauma Centre. Patients aged 18 years or above with blunt trauma chest with GCS > 13 at presentation were included. Data analysis was performed using IBM SPSS. The receiver operator curve (ROC) was used to evaluate the statistical significance of sensitivity and specificity and to choose suitable cut-off points to make a decision. Results: Out of 300 patients, 230 were male (76.7%) and aged 38 +/- 14.5 years. Road Traffic Accident was the commonest mode of injury (71.6%). Out of 239 patients who were admitted, 137 patients needed hospitalization for less than 7 days (good prognosis), 44 patients had fair prognosis, 27 needed admission to ICU and ventilator support and therefore had poor prognosis while 31 patients had fatal outcome. A cutoff of TTSS 11 or more had 96% sensitivity & 90% specificity for predicting poor outcome (p < 0.001; AUC = 0.921) and 87.4% sensitivity & 86.5% specificity for predicting fatal outcome (p < 0.001; AUC = 0.933). Conclusion: A TTSS score of 11 and above was associated with poor (ICU admission and need for mechanical ventilation) and fatal outcome. A higher score is associated with higher morbidity & mortality [Level of evidence: Level 2].