Together is better - RibScore and SCARF in the prediction of pulmonary complications and association with SSRF

Kabytto Chen; Bayan Minasian; Evangeline Woodford; Pranav Shivashankar; Kah Ann Ho; Saimurooban Muralidaran; James Elhindi; Jeremy Hsu

doi:10.1016/j.injury.2024.111562

Together is better - RibScore and SCARF in the prediction of pulmonary complications and association with SSRF

Injury. 2024 Apr 13:111562. doi: 10.1016/j.injury.2024.111562. Online ahead of print.

Authors

Kabytto Chen¹, Bayan Minasian², Evangeline Woodford², Pranav Shivashankar², Kah Ann Ho², Saimurooban Muralidaran², James Elhindi³, Jeremy Hsu²

Affiliations

¹ Discipline of Surgery, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Trauma Service, Department of Surgery, Westmead Hospital, Sydney, Australia. Electronic address: kabytto.chen@health.nsw.gov.au.
² Discipline of Surgery, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Trauma Service, Department of Surgery, Westmead Hospital, Sydney, Australia.
³ Discipline of Surgery, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.

PMID: 38649314
DOI: 10.1016/j.injury.2024.111562

Abstract

Background: Optimal treatment of patients with rib fractures requires identification of those patients at risk of pulmonary complications. It is also important to determine which patients would benefit from Surgical Stabilisation of Rib Fractures (SSRF). This study aims to validate two scoring systems (RibScore and SCARF score) in predicting complications and association with SSRF in an Australian trauma population. Clinical observation suggests that complications and criteria for SSRF is associated with anatomical and physiological factors. Therefore it is hypothesized that utilisation of an anatomical (RibScore) and physiological (SCARF) in conjunction will have improved predictive ability.

Method: Retrospective cohort study of rib fracture patients admitted to an Australian Level I trauma centre from Jan 2017 to Jan 2021. RibScore and SCARF score were calculated. Multivariate logistic regression was performed to determine risk factors associated with complications and SSRF, as well the scoring systems' ability via ROC AUC.

Results: 1157 patients were included. Higher median RibScore (1vs0; p < 0.001) and SCARF score (3vs1, p < 0.001) was associated with development of complications. Similarly for SSRF, RibScore (3vs0; p < 0.001), SCARF score (3vs1; p < 0.001) were higher. On multivariate analysis, increasing RibScore and SCARF score were associated with an increased risk of respiratory failure, pneumonia, death, and SSRF. The sensitivity for a patient with a high risk score in either RibScore or SCARF increased to 96.3 % in identifying pulmonary complications (from 66.7 % in RibScore and 88 % in SCARF, when used individually) and 91.9 % in identifying association with SSRF (from 86.5 % in RibScore and 70.3 % in SCARF).

Conclusion: RibScore and SCARF score demonstrate predictive ability for complications and SSRF in an Australian trauma rib fracture population. Combining a radiological score with a clinical scoring system demonstrates improved sensitivity over each score individually for identifying patients at risk of complications from rib fractures, those who may require SSRF, and those who are low risk.

Study type: Retrospective Cohort Study LEVEL OF EVIDENCE: Level III.

Keywords: Open reduction internal fixation; Pulmonary complications; Rib fracture; Ribscore; Scarf; Surgical stabilisation of rib fractures.