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.
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