Thorax Trauma Severity Score in Chest Trauma: A Study in Iraq

NCT ID: NCT06744959

Last Updated: 2025-08-07

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Total Enrollment

166 participants

Study Classification

OBSERVATIONAL

Study Start Date

2025-07-22

Study Completion Date

2026-05-10

Brief Summary

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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

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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.

Conditions

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Chest Trauma

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Eligibility Criteria

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Inclusion Criteria

* patients above 16 years of age.
* 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.
* chronic respiratory diseases
* malignancy and end-organ failure
* Patients with severe head injury (having extradural, subdural, subarachnoid, or intraparenchymal hemorrhage and skull bone fracture) or those requiring prior neurosurgical intervention
* patients with severe abdominal injury requiring surgical intervention like laparotomy
Minimum Eligible Age

16 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Al-Nahrain University

OTHER

Sponsor Role lead

Responsible Party

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Abdul-Ilah R. Khamis

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Luma K Mohammed, Assistant professor

Role: STUDY_DIRECTOR

Al-Nahrain University

Locations

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College of Medicine - Al-Nahrain University

Baghdad, , Iraq

Site Status RECRUITING

Countries

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Iraq

Central Contacts

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Abdulillah R. Khamees Al-Mamoori, MBBCH

Role: CONTACT

07838571013

Facility Contacts

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Luma K Mohammed, MBChB,FIBMS/CM

Role: primary

+964770225676

References

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Moore EE, Malangoni MA, Cogbill TH, Shackford SR, Champion HR, Jurkovich GJ, McAninch JW, Trafton PG. Organ injury scaling. IV: Thoracic vascular, lung, cardiac, and diaphragm. J Trauma. 1994 Mar;36(3):299-300. No abstract available.

Reference Type BACKGROUND
PMID: 8145307 (View on PubMed)

Rating the severity of tissue damage. I. The abbreviated scale. JAMA. 1971 Jan 11;215(2):277-80. doi: 10.1001/jama.1971.03180150059012. No abstract available.

Reference Type BACKGROUND
PMID: 5107365 (View on PubMed)

Boyd CR, Tolson MA, Copes WS. Evaluating trauma care: the TRISS method. Trauma Score and the Injury Severity Score. J Trauma. 1987 Apr;27(4):370-8.

Reference Type BACKGROUND
PMID: 3106646 (View on PubMed)

Bozorgi F, Mirabi A, Chabra A, Mirabi R, Hosseininejad S-M, Zaheri H. Mechanisms of traumatic injuries in multiple trauma Patients. Int J Med Invest. 2018;7:7-15

Reference Type BACKGROUND

Khandhar SJ, Johnson SB, Calhoon JH. Overview of thoracic trauma in the United States. Thorac Surg Clin. 2007 Feb;17(1):1-9. doi: 10.1016/j.thorsurg.2007.02.004.

Reference Type BACKGROUND
PMID: 17650692 (View on PubMed)

Aukema TS, Beenen LF, Hietbrink F, Leenen LP. Validation of the Thorax Trauma Severity Score for mortality and its value for the development of acute respiratory distress syndrome. Open Access Emerg Med. 2011 Aug 23;3:49-53. doi: 10.2147/OAEM.S22802. eCollection 2011.

Reference Type RESULT
PMID: 27147852 (View on PubMed)

Pape HC, Remmers D, Rice J, Ebisch M, Krettek C, Tscherne H. Appraisal of early evaluation of blunt chest trauma: development of a standardized scoring system for initial clinical decision making. J Trauma. 2000 Sep;49(3):496-504. doi: 10.1097/00005373-200009000-00018.

Reference Type RESULT
PMID: 11003329 (View on PubMed)

Wutzler S, Wafaisade A, Maegele M, Laurer H, Geiger EV, Walcher F, Barker J, Lefering R, Marzi I; Trauma Registry of DGU. Lung Organ Failure Score (LOFS): probability of severe pulmonary organ failure after multiple injuries including chest trauma. Injury. 2012 Sep;43(9):1507-12. doi: 10.1016/j.injury.2010.12.029. Epub 2011 Jan 21.

Reference Type RESULT
PMID: 21256489 (View on PubMed)

Clark GC, Schecter WP, Trunkey DD. Variables affecting outcome in blunt chest trauma: flail chest vs. pulmonary contusion. J Trauma. 1988 Mar;28(3):298-304. doi: 10.1097/00005373-198803000-00004.

Reference Type RESULT
PMID: 3351988 (View on PubMed)

Chrysou K, Halat G, Hoksch B, Schmid RA, Kocher GJ. Lessons from a large trauma center: impact of blunt chest trauma in polytrauma patients-still a relevant problem? Scand J Trauma Resusc Emerg Med. 2017 Apr 20;25(1):42. doi: 10.1186/s13049-017-0384-y.

Reference Type RESULT
PMID: 28427480 (View on PubMed)

Other Identifiers

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UNCOMIRB20241212B

Identifier Type: -

Identifier Source: org_study_id

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