Validation of the Thorax Trauma Severity Score for mortality and its value for the development of acute respiratory distress syndrome

Tjeerd S Aukema1, Ludo FM Beenen2, Falco Hietbrink1, Luke PH Leenen11Department of Surgery, University Medical Center Utrecht, Utrecht, 2Department of Radiology, Academic Medical Center, Amsterdam, The NetherlandsBackground: The aim of the present study was to evaluate and to validate the Thorax Trauma Severity Score for mortality (TTSS).Methods: By database analysis 712 patients with an injury to the chest admitted to the Universal Medical Center Utrecht between 2000 and 2004 were studied. All patients with a score of ≥1 on the AISthorax were included in the study. The patients' file was evaluated for: TTSS, intensive care unit stay, days on ventilation, thorax trauma-related complications (eg, acute respiratory distress syndrome [ARDS]), total hospital stay, and mortality.Results: Of the 516 patients included in the study, 140 (27%) developed thorax-related complications. The overall in-hospital mortality rate was 10%. The receiver operating characteristic curve for predicting mortality demonstrated an adequate discrimination by a value of 0.844. The TTSS was statistically significant higher in patients who died of thorax-related complications than in patients who died because of nonthorax-related complications and survivors (P <0.001, confidence interval [CI] 95%). In patients who developed ARDS the TTSS was significant higher (P = 0.005, CI 95%).Conclusion: This study supports the use of the TTSS for predicting mortality in thoracic injury patients. Furthermore, the TTSS appears capable of predicting ARDS.Keywords: wounds and injuries, thorax, trauma severity indices, acute respiratory distress syndrome, mortality