Zehr et al developed a risk score for a patient with flail chest. The score can help to identify a patient who may benefit from more aggressive management. The authors are from Western University in London, Ontario, Canada.
Patient selection: adult with flail chest
Parameters:
(1) age in years
(2) Glasgow coma score (GCS)
(3) ventilation
(4) cardiopulmonary resuscitation (CPR)
(5) number of significant comorbid conditions (from Charlson comorbidity index and Elixhauser model)
Parameter |
Finding |
Points |
---|---|---|
age in years |
20 to 29 |
0 |
|
30 to 39 |
2 |
|
40 to 49 |
4 |
|
50 to 59 |
6 |
|
60 to 69 |
8 |
|
70 to 79 |
10 |
|
80 to 89 |
12 |
|
90 to 99 |
14 |
GCS |
15 |
0 |
|
< 15 |
2 |
ventilation |
no |
0 |
|
yes |
3 |
CPR |
no |
0 |
|
yes |
3 |
number of comorbidities |
|
< number >
|
where:
• The handling of comorbidities is a bit vague.
• An alternative for age is an equation with points = 2 * MAX(0,((age)-20)/10)
total score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: > 20
• The higher the score the greater the risk for mortality (time frame not stated).
Score |
Risk Group |
Mortality |
---|---|---|
0 to 5 |
low |
1.3% |
6 to 10 |
intermediate |
4.6% |
11 to 15 |
high |
22% |
>= 16 |
very high |
46% |
Performance:
• The area under the ROC curve was 0.83.
Specialty: Surgery, orthopedic, Emergency Medicine, Critical Care, Surgery, general, Cardiology
ICD-10: ,