Citation

Alaniz L, Muttalib O, Hoyos J, Figueroa C, Barrios CJ. Am. Surg. 2021; ePub(ePub): ePub.

Copyright

(Copyright © 2021, Southeastern Surgical Congress)

DOI

10.1177/00031348211024973

PMID

unavailable

Abstract

INTRODUCTION: Extensive research relying on Injury Severity Scores (ISS) reports a mortality benefit from routine non-selective thoracic CTs (an integral part of pan-computed tomography (pan-CT)s). Recent research suggests this mortality benefit may be artifact. We hypothesized that the use of pan-CTs inflates ISS categorization in patients, artificially affecting admission rates and apparent mortality benefit.

METHODS: Eight hundred and eleven patients were identified with an ISS >15 with significant findings in the chest area. Patient charts were reviewed and scores were adjusted to exclude only occult injuries that did not affect treatment plan. Pearson chi-square tests and multivariable logistic regression were used to compare adjusted cases vs non-adjusted cases.

RESULTS: After adjusting for inflation, 388 (47.8%) patients remained in the same ISS category, 378 (46.6%) were reclassified into 1 lower ISS category, and 45 (5.6%) patients were reclassified into 2 lower ISS categories. Patients reclassified by 1 category had a lower rate of mortality (P < 0.001), lower median total hospital LOS (P <.001), ICU days (P <.001), and ventilator days (P = 0.008), compared to those that remained in the same ISS category.

CONCLUSION: Injury Severity Score inflation artificially increases survival rate, perpetuating the increased use of pan-CTs. This artifact has been propagated by outdated mortality prediction calculation methods. Thus, prospective evaluations of algorithms for more selective CT scanning are warranted.

Language: en

Keywords

ISS inflation; occult hemothorax; occult pneumothorax; occult rib fracture; occult thoracic injury; pan-CT scan; pulmonary contusion; thoracic CT scan