Emond et al developed a simple clinical decision rule for identifying a patient at risk for delayed hemothorax following minor chest trauma. The authors are from Universite Laval, Universite de Montreal and multiple hospitals in Canada.
Patient selection: >= 16 years of age after minor thoracic injury (chest abrasion, chest contusion, traumatic chest pain, rib fracture; mechanism fall, motor vehicle accident. direct hit, other)
Outcome: delayed hemothorax (any pleural fluid in follow-up upright chest X-ray at 7 or 14 days after discharge from ED)
Parameters:
(1) age in years
(2) location of rib fracture
(3) number of rib fractures
Parameters
Finding
Points
age of the patient
< 45 years
0
45 to 69 years
1
>= 70 years
2
number of rib fractures
0 to 2
0
3 or more
1
location of rib fractures
none or low
0
mid or high
2
total score =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: 0
• maximum score: 5
• The higher the score the greater the risk for delayed hemothorax.
Score
Risk
Percentage
0 or 1
low
< 8%
2 or 3
moderate
16%
4 or 5
high
31-38%
Performance:
• The area under the ROC curve is 0.78.
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