Can a standardized blunt thoracic trauma score lead to lower length of stay and reduced intensive care unit admission for older patients?

OBJECTIVE

We implemented and evaluated a novel score called the blunt thoracic trauma score (BTTS) for the triage of chest wall injury (CWI) patients to optimize utilization of the intensive care unit (ICU).

METHOD: Patients who sustained rib fractures after a traumatic injury (2014-2020) were identified in our trauma registry. Demographics and clinical characteristics were summarized by cohorts pre- and post-BTTS implementation in 2017 and BTTS > 6 versus BTTS < 6 using median or frequency. Wilcoxon rank-sum test was used to compare continuous variables, and χ2 or Fisher's exact test for categorical variables. Logistic/negative binomial regression models were used to find predictors for ICU admission and length of stay (LOS).

RESULTS

Six hundred thirty-three patients were included; 407 pre-BTTS/226 post-BTTS. Pre-BTTShigher median ISS (p < 0.001), more rib fractures (p < 0.001). Post-BTTS older (p < 0.001), more comorbidities (coronary artery disease [p = 0.028], hyperlipidemia [p = 0.004], pulmonary disease [p = 0.038]). Post-BTTS cohort had lower rates of ICU admission (p = 0.008), shorter ICU-LOS (p < 0.001), and Hospital-LOS (p < 0.001). Post-BTTS cohort was associated with shorter Hospital-LOS after adjusting for other factors (p = 0.004).

CONCLUSIONS

Implementation of a novel BTTS for triage of CWI was associated with decreased ICU admission rates and shorter ICU-LOS and Hospital-LOS. The decreased Hospital-LOS persisted even after controlling for other factors.