Validation of Thorax Trauma Severity Score Using Early Emergency Department Computed Tomography (MDCT 64 Slice/ Multirow Detector CT)
Journal Title: Journal of Medical Science And clinical Research - Year 2016, Vol 4, Issue 12
Abstract
Background: Rapid and accurate assessment of the thoracic trauma is important to direct life-saving and definitive management. In traumatic lung injury patients, till date thorax trauma severity score (TTSS) was calculated by using conventational X raychest. MDCT 64 slice (Multirow Detector -CT) Scan has significantly shorter scanning time and higher injury detection rate than conventional X-ray chest and single slice CT Scan (SSCT). We observed role of early emergency CT scan Thorax (MDCT) in traumatic lung injury patients. Objective: The aim of this study is to validate thorax trauma severity score (TTSS) using early MDCT 64 slice (Multirow Detector -CT). Material & Methods: In this retrospective study, 80 patients of Isolated chest injuries (blunt and penetrating chest injuries) having AIS THORAX > 1 admitted at King George's Medical University Trauma Centre, Luck now ,between June 2012 to July 2013 who were scanned early in Emergency Department with MDCT 64-slice and helical single slice CT using the standardized multiple trauma protocol(ATLS guidelines), were eligible for the study.All records were noted from case sheet from the time of admission and subsequently followed regarding suitable management like surgical intervention or mechanical ventilation or thorax related complication or follow up complications. Results: Of the 80 patients included in the study, 52 (65%) developed thoraxrelated complications. The overall inhospital mortality rate was 10%. The receiver operating characteristic(ROC) curve for predicting mortality demonstrated an adequate discrimination by a statistically significant higher Area under curve (AUC) in patients who died of thorax-related complications than in patients who survived (P =0.002, confidence interval [CI] 95% for TTSS MDCT). In patients who developed ARDS the TTSS was significant higher (P = 0.0001, CI 95%).Area under curve (AUC) of TTSS ROC curve was highest for MDCT (0.81) then for Single slice CT (0.79 ) and least for x-ray(0.78 ), indicating highest sensitivity, specificity and predictive ability of MDCT, then SSCT and conventional x-ray for predicting mortality in emergency department. Area under curve (AUC) of TTSS ROC curve was highest for MDCT( 0.92) then for Single slice CT ( 0.85)and least for x-ray (0.81), indicating highest sensitivity, specificity and predictive ability of MDCT, then Single slice CT and conventional x-ray for predicting ARDS. Conclusion: This study validate the Thoracic Trauma Severity Score(TTSS) with new emerging concept of early emergency Department Muti- row detector CT in secondary survey for predicting mortality in critically ill thoracic injury patients. TTSS MDCT (thorax trauma severity score on the basis of MDCT64 slice findings) appears capable of predicting ARDS more precisely then TTSSx-ray (thorax trauma severity score on the bases of chest x-ray findings).Thus shows the significance of early emergency MDCT in diagnostics and treatment decisions in traumatic lung injured patients.
Authors and Affiliations
Anurag Rai
Keywords
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