Yesha Maniar, Department of Surgery, NYU Grossman Long Island School of Medicine, NYU Langone Hospital Long Island, Mineola, New York, USA
Leo I. Amodu, Department of Surgery, NYU Grossman Long Island School of Medicine, NYU Langone Hospital Long Island, Mineola, New York, USA
Patrizio Petrone, Department of Surgery, NYU Grossman Long Island School of Medicine, NYU Langone Hospital Long Island, Mineola, New York; Chairman, Research Committee, Panamerican Trauma Society, Richmond, Virginia: USA
Armin Mahabadi, Department of Surgery, NYU Grossman Long Island School of Medicine, NYU Langone Hospital Long Island, Mineola, New York, USA
Maria Bower, Department of Surgery, NYU Grossman Long Island School of Medicine, NYU Langone Hospital Long Island, Mineola, New York, USA
Sakib Safi, Department of Surgery, NYU Grossman Long Island School of Medicine, NYU Langone Hospital Long Island, Mineola, New York, USA
Gerard Baltazar, Department of Surgery, NYU Grossman Long Island School of Medicine, NYU Langone Hospital Long Island, Mineola, New York, USA
Shahidul Islam, Biostatistics Unit, Office of Academic Affairs, Northwell Health, New Hyde Park, New York; Division of Health Services Research, Department of Foundations of Medicine, Biostatistics Core, NYU Grossman Long Island School of Medicine, New York; USA
DAndrea K. Joseph, Department of Surgery, NYC Health Hospitals, Elmhurst, New York, USA
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-BTTS: higher 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.
Keywords: Chest wall injury. Blunt. Admission. Critical care. Thoracic trauma. Triage.