Trauma is a significant cause of mortality and morbidity around the world. Approximately
10% of the burden of disease in adults is due to traumatic injuries. Trauma can lead to
serious consequences, including disabilities, psychosocial burdens, and increased
mortality among the actively working population. Cardiopulmonary arrest, unplanned
admissions to intensive care units, and nosocomial infections are some complications
faced by trauma patients admitted to trauma centers. The estimated mortality rate for
hospitalized trauma patients is 11%. The in-hospital mortality rate for trauma patients
who undergo cardiopulmonary resuscitation (CPR) is 92.7%. Trauma-related mortality and
morbidity depend on injury severity, diagnostic delays, and the time taken to reach a
medical facility. Timely evaluation, effective post-trauma care, and appropriate triage
can significantly reduce long-term mortality and morbidity among trauma patients, with
rapid assessment of trauma severity being crucial for the primary triage of multiple
trauma patients.
Trauma scoring systems are essential tools in the medical field for evaluating the
severity of injuries and predicting patient outcomes. Two notable scoring systems are the
Thorax Trauma Severity Score (TTSS) and the Trauma and Injury Severity Score (TRISS),
each serving unique purposes in assessing thoracic injuries and overall trauma severity.
The TTSS was developed to provide a comprehensive assessment of thoracic injuries by
incorporating both anatomical and physiological parameters. It specifically focuses on
various aspects of chest trauma, including:
Age of the patient Ratio of arterial oxygen partial pressure to fractional inspired
oxygen (PaO2/FiO2) Presence of pleural injuries Lung contusions Rib fractures The scoring
system ranges from 0 to 25 points, where higher scores indicate more severe injuries and
worse prognoses. Research has shown that a TTSS score of 7 or above is highly predictive
of morbidity and mortality, achieving 100% sensitivity and 97.73% specificity for poor
outcomes in isolated thoracic trauma cases. The TRISS is another critical scoring system
used to evaluate overall injury severity across multiple body regions. It is based on the
Injury Severity Score (ISS), which categorizes injuries according to their anatomical
location using the Abbreviated Injury Scale (AIS). The ISS is calculated by taking the
highest AIS scores from the three most severely injured body regions, squaring them, and
summing these values.
Despite their utility, both TTSS and TRISS have limitations, especially when applied to
diverse patient populations. The TTSS may not adequately account for the severity of
injuries outside the thoracic region, which can significantly impact patient outcomes.
For instance, a study highlighted that in patients with an Injury Severity Score (ISS)
greater than 15, only 44% had a TTSS above 8, indicating that critical extra-thoracic
injuries were not reflected in the TTSS scoring. Older patients or those with
comorbidities may present with less obvious thoracic injuries that the TTSS fails to
identify. This oversight can lead to underestimating the risk of complications or
mortality, as older individuals often have a higher propensity for severe outcomes
despite seemingly minor trauma. The TISS may not capture specific details related to
chest trauma effectively. This limitation is crucial in regions with variable healthcare
infrastructure, like Iraq, where injury mechanisms and patient demographics can differ
widely. The TRISS's general approach may overlook critical factors that influence trauma
severity in these populations.
This study seeks to address the specific needs of the Iraqi healthcare system by
comparing the TTSS and TRISS as predictive tools for chest trauma outcomes in emergency
settings. The aim is to identify which scoring system is more reliable and practical for
use in Iraq, considering the unique challenges faced by emergency departments, such as
high patient volumes and resource constraints. The research fills a critical gap in the
literature by providing data specific to Iraq, where comparative analyses of these
scoring systems are lacking. Insights gained from this study could inform local
protocols, enhance triage efficiency, and improve patient outcomes in Iraqi emergency
departments .
