Clinical trial NCT06744959: Thorax Trauma Severity Score in Chest Trauma: A Study in Iraq
Official title: Reliability of Thoracic Trauma Severity Scores in Predicting Outcomes Among Chest Trauma Patients in Low-Resource Settings: A Prospective Cohort Study From Iraq
Study type: OBSERVATIONAL
Overall status: NOT_YET_RECRUITING
Conditions: Chest Trauma
Keywords: TTSS
Chest
Trauma
Lead sponsor: Al-Nahrain University
Sponsor class: OTHER
First posted: 2024-12-20
Enrollment: 166
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: The study population includes adult patients aged 18 years and older presenting with chest trauma, including both blunt and penetrating injuries, at the emergency department of a tertiary hospital in Iraq. Participants will be evaluated for injury severity using the Thorax Trauma Severity Score (TTSS), with demographic and clinical data collected to explore outcome predictors. This population represents a diverse cohort reflective of trauma patterns in a resource-limited setting.

Brief summary: This prospective observational study aims to evaluate the predictive utility of the Thorax Trauma Severity Score (TTSS) in determining morbidity and mortality in patients presenting with chest trauma at a tertiary hospital in Iraq. The primary objectives of the study are:

To assess the accuracy of TTSS in predicting mortality and critical outcomes such as ICU admission and the need for advanced interventions.

To evaluate the utility of TTSS in stratifying patients based on injury severity in a resource-constrained setting.

To identify demographic and clinical factors influencing the predictive performance of TTSS.

Participants will:

Be assessed using the TTSS upon arrival at the emergency department to establish risk stratification.

Provide demographic and clinical data, including age, gender, mechanism of injury, comorbidities, and length of hospital stay, for analyzing associations with clinical outcomes.

Detailed description: Chest trauma encompasses a wide range of injuries from small rib fractures to potentially fatal thoracic organ injury, making it a major problem in emergency medicine and trauma care. Common causes of chest trauma include motor vehicle collisions (MVCs), falls, and attacks. After head trauma and abdominal damage, chest trauma is the third most prevalent cause of death for patients with polytrauma and the second most common unintended traumatic injury. Death rates from chest trauma are the highest; in some studies, they can reach 60%. Chest trauma is responsible for 25% of mortality in patients with severe trauma. The main causes of death in these situations are frequently ascribed to hypoxia, severe bleeding, or postponed surgery. As such, prompt diagnosis and careful evaluation of the extent of chest damage are essential for enhancing patient outcomes and reducing morbidity and death.

Correct treatment of thoracic trauma, from anticipating the need for urgent care to addressing potential sequelae, depends on an early and precise assessment of the severity level. The requirement for a precise scale in the assessment of thoracic trauma is highlighted by the fact that no scale now in use can accomplish this. Although frequently used, scales like the Trauma Injury Severity Score (TRISS) and the Injury Severity Score (ISS) are global poly-trauma measures that understate localized thoracic damage. The Lung Injury Scale and the Abbreviated Injury Scale (AIStorax) are two other thoracic measures that only use anatomical results. The presence of three or more rib fractures, especially a fracture of the first rib, has traditionally been thought to be related with increased severity. It is currently unclear how factors like age, the mechanism, and the extent of the injury relate to the emergence of pulmonary problems.

Both anatomical and functional criteria were included in the Thorax Trauma Severity Score (TTSS), which was described by Pape et al. in 2000. Using characteristics accessible during the initial examination, the scale was designed to assist emergency medical evaluation in identifying trauma patients at risk of pulmonary problems. This evaluation could be used in both primary and secondary level hospitals. The ability of this scale to predict death has recently been verified. With a score ranging from 0 to 25 points, the TTSS takes into account five important factors: age, pleural injuries, lung contusions, rib fractures, and the PaO2/FiO2 ratio.

Although the TTSS may be useful, its validity about Iraqi hospitals has not yet been fully assessed. This study attempts to close this gap by evaluating the TTSS's prognostic function in forecasting the outcomes of thoracic trauma at tertiary-level hospitals in Iraq. The study aims to ascertain the efficacy of TTSS in a community context and pinpoint precise cut-off points that could help medical professionals make well-informed choices about patient care and treatment plans.

Eligibility criteria: Inclusion Criteria:

* Patients who present within 4 hours of sustaining the injury.
* Patients presenting to the emergency department with thoracic trauma.
* Patients or their legal guardians must provide informed consent to participate in the study.

Exclusion Criteria:

* Patients with incomplete clinical data or those discharged before scoring can be performed.
* Pregnant patients (due to specific physiological considerations not accounted for by the scoring system).
* Patients who succumb to their injuries before scoring or baseline data collection.
* Pediatric patients under 18 years of age.

Primary outcomes:
measure: In hospital mortality
timeFrame: In-Hospital Phase (average of 10 days through discharge)
measure: Accuracy Assessment of Thorax trauma severity score (TTSS)
timeFrame: the first 4 hours after ER admission
Secondary outcomes:
measure: Number of Participants Requiring ICU Admission
timeFrame: Up to discharge, an average of 10 days
measure: Length of Hospitalization
timeFrame: Up to discharge, an average of 10 days
measure: Number of Participants Requiring Surgical Intervention.
timeFrame: Up to discharge, an average of 10 days
Other outcomes:
Locations:
city: Baghdad
country: Iraq
facility: College of Medicine - Al-Nahrain University
Study officials:
affiliation: Al-Nahrain University
name: Luma K Mohammed, Assistant professor
role: STUDY_DIRECTOR
References:
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