Quantification of rib fractures by different scoring systems

Abstract

Background: The three known systems for evaluation of patients with rib fractures are rib fracture score (RFS), chest trauma score (CTS), and RibScore (RS). The aim was to establish critical values for these systems in different patient populations.

Methods: Retrospective cohort study included 1089 patients with rib fractures, from level-1 trauma center; divided into two groups: first group included 620 nongeriatric patients, and second group included 469 geriatric patients (≥65 y.o.). Additional variables included mortality, injury severity score (ISS), hospital and intensive care unit lengths of stay (HLOS, ICULOS), duration of mechanical ventilation, rate of pneumonia (PN), tracheostomy, and epidural analgesia.

Results: RFS critical values were 10 for nongeriatric and eight for geriatric patients, CTS were four and six respectively, and RS were one for both. Nongeriatric patients with RFS ≥10 versus RFS <10, had higher mortality, ISS, HLOS, ICULOS, and tracheostomy (P <0.03). Geriatric patients with RFS ≥8 versus RFS <8, had higher mortality, ISS, HLOS, ICULOS, and PN (P <0.03). Nongeriatric patients with CTS ≥4 versus CTS <4, had higher mortality, ISS, HLOS, ICULOS, duration of mechanical ventilation, and PN (P < 0.02). Geriatric patients with CTS ≥6 versus CTS <6 had greater values for all variables (P < 0.01). Both groups with RS ≥1 versus RS <1, had greater values for all variables (P < 0.05). In geriatric group, prediction of PN was good by CTS (c = 0.8) and fair by RFS and RS (c = 0.7).

Conclusions: Physicians should choose score to match specific population and collected variables. RFS is simple but sensitive in elderly population. CTS is recommended for geriatric patients as it predicts PN the best. RS is recommended for assessment of severely injured patients with high ISS.

Keywords: Blunt chest trauma; Chest trauma score; Clinical scoring systems; Rib fracture score; Rib fractures; RibScore.