Aurélien Daurat1, Ingrid Millet2, Jean-Paul Roustan3, Camille Maury4, Patrice Taourel5, Samir Jaber6, Xavier Capdevila7, Jonathan Charbit8. 1. Trauma Intensive and Critical Care Unit, Lapeyronie University Hospital, Montpellier, France. Electronic address: daurat.aurelien@gmail.com. 2. Department of Radiology, Lapeyronie University Hospital, Montpellier, France. Electronic address: i-millet@chu-montpellier.fr. 3. Trauma Intensive and Critical Care Unit, Lapeyronie University Hospital, Montpellier, France. Electronic address: jp-roustan@chu-montpellier.fr. 4. Trauma Intensive and Critical Care Unit, Lapeyronie University Hospital, Montpellier, France. Electronic address: c-maury@chu-montpellier.fr. 5. Department of Radiology, Lapeyronie University Hospital, Montpellier, France. Electronic address: p-taourel@chu-montpellier.fr. 6. Intensive Care Unit and Transplantation, Critical Care and Anesthesia Department (DAR B), Saint-Éloi University Hospital, Montpellier, France; Institut National de la Santé et de la Recherche Médicale, Inserm U1046, Montpellier, France. 7. Trauma Intensive and Critical Care Unit, Lapeyronie University Hospital, Montpellier, France; Institut National de la Santé et de la Recherche Médicale, Inserm U1046, Montpellier, France. Electronic address: s-jaber@chu-montpellier.fr. 8. Trauma Intensive and Critical Care Unit, Lapeyronie University Hospital, Montpellier, France. Electronic address: j-charbit@chu-montpellier.fr.
Abstract
BACKGROUND: Pulmonary 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. METHODS: All 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. RESULTS: Of 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). CONCLUSIONS: An 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.
BACKGROUND: Pulmonary contusion is a major risk factor of acute respiratory distress syndrome (ARDS) in traumapatients. 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 traumapatients with pulmonary contusion. METHODS: All blunt thoracic traumapatients 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. RESULTS: Of 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). CONCLUSIONS: An extreme TTS score on admission accurately predicts the occurrence of delayed ARDS in blunt thoracic traumapatients affected by pulmonary contusion. This simple score could guide early decision making and management for a non-negligible proportion of this specific population.
Authors: Anamaria J Robles; Lucy Z Kornblith; Carolyn M Hendrickson; Benjamin M Howard; Amanda S Conroy; Farzad Moazed; Carolyn S Calfee; Mitchell J Cohen; Rachael A Callcut Journal: J Trauma Acute Care Surg Date: 2018-07 Impact factor: 3.313
Authors: Marcel Winkelmann; Jan-Dierk Clausen; Pascal Graeff; Christian Schröter; Christian Zeckey; Sanjay Weber-Spickschen; Philipp Mommsen Journal: In Vivo Date: 2019 Sep-Oct Impact factor: 2.155
Authors: Kirsten A Freeman; Mauricio Pipkin; Tiago N Machuca; Eric Jeng; Olusola Oduntan; Frederick A Moore; Yong G Peng; Joseph Philip; Desiree Machado; Thomas M Beaver Journal: JTCVS Tech Date: 2022-02-24
Authors: K Horst; T P Simon; R Pfeifer; M Teuben; K Almahmoud; Q Zhi; S Aguiar Santos; C Castelar Wembers; S Leonhardt; N Heussen; P Störmann; B Auner; B Relja; I Marzi; A T Haug; M van Griensven; M Kalbitz; M Huber-Lang; R Tolba; L K Reiss; S Uhlig; G Marx; H C Pape; F Hildebrand Journal: Sci Rep Date: 2016-12-21 Impact factor: 4.379