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. 2024 Mar 1;96(3):466-470.
doi: 10.1097/TA.0000000000004199. Epub 2023 Nov 15.

External validation of novel Revised Intensity Battle Score and comparison of static rib fracture scoring systems

Carl J Buchholz  1 , Madeline L D'Aquila, Daniel I Lollar
Affiliations

External validation of novel Revised Intensity Battle Score and comparison of static rib fracture scoring systems

Carl J Buchholz et al. J Trauma Acute Care Surg. .

Abstract

Background: This study aims to compare and externally validate the previously developed Revised Intensity Battle Score (RIBS) against other proposed scores for predicting poor outcomes after rib fractures.

Methods: An external validation set was assembled retrospectively, comprising 1,493 adult patients with one or more rib fractures admitted to a Level 1 trauma center between 2019 and 2022. The following rib fracture scores were calculated for each patient: RIBS, Injury Severity Score, Rib Fracture Score, Chest Trauma Score, and Battle score. Each was investigated to assess utility in predicting mortality, intensive care unit upgrade, unplanned intubation and ventilator days. Performance was measured by area under the receiver operating characteristic curve.

Results: Of the 1,493 patients who met inclusion criteria, 239 patients (16%) experienced one of more of the investigated outcomes. Generally, scores performed best at predicting mortality and ventilator days. The RIBS stood out as best predicting "any complication" (AUC = 0.735) and ">7 ventilator days" (AUC = 0.771).

Conclusion: The RIBS represents an externally validated triage score in patients with rib fractures and compares favorably to other static scoring systems. Use of this score as a triage tool may allow stratifying patients who may benefit from direct intensive care unit admission, neuraxial anesthesia and aggressive respiratory care. Next steps include prospective investigation of how pairing these interventions with score directed triage impacts outcomes.

Level of evidence: Prognostic and Epidemiological; Level IV.

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References

    1. Sirmali M, Türüt H, Topçu S, Gülhan E, Yazici U, Kaya S, et al. A comprehensive analysis of traumatic rib fractures: morbidity, mortality and management. Eur J Cardiothorac Surg . 2003;24:133–138.
    1. Murphy CE, Raja AS, Baumann BM, Medak AJ, Langdorf MI, Nishijima DK, et al. Rib fracture diagnosis in the Panscan era. Ann Emerg Med . 2017;70:904–909.
    1. Brasel KJ, Guse CE, Layde P, Weigelt JA. Rib fractures: relationship with pneumonia and mortality. Crit Care Med . 2006;34:1642–1646.
    1. Sum SK, Peng YC, Yin SY, Huang PF, Wang YC, Chen TP, et al. Using an incentive spirometer reduces pulmonary complications in patients with traumatic rib fractures: a randomized controlled trial. Trials . 2019;20:797.
    1. Mangram AJ, Sohn J, Zhou N, Hollingworth AK, Ali-Osman FR, Sucher JF, et al. Trauma-associated pneumonia: time to redefine ventilator-associated pneumonia in trauma patients. Am J Surg . 2015;210:1056–1061 discussion 1061-1062.