{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T15:38:47Z","timestamp":1767713927346,"version":"3.48.0"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T00:00:00Z","timestamp":1766102400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate and test the prognostic performance of a modified TTSS that adds body mass index (BMI) and Glasgow Coma Scale (GCS), with emphasis on polytrauma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Prospective observational study of 302 adults with blunt chest trauma (December 2022-May 2023). Patients were stratified into isolated thoracic trauma and polytrauma. We assessed in-hospital mortality and prolonged hospital stay (&amp;gt;7 days) using ROC analysis and multivariate logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Mean age 44.6\u2009\u00b1\u200917.1 years; 88.7% male; 50.3% polytrauma; mortality 12.9%. For mortality, modified TTSS discriminated better than TTSS (AUC 0.857 vs. 0.729); cut-offs were &amp;gt;8 and &amp;gt;6, respectively. For prolonged stay, performance was modest overall, with slight improvement using Modified TTSS (AUC 0.657 vs. 0.644; cut-offs &amp;gt;7 vs. &amp;gt;6). In polytrauma, modified TTSS again outperformed TTSS for mortality (AUC 0.821 vs. 0.680). On multivariable analysis, TTSS &amp;gt;6 and Modified TTSS &amp;gt;8 independently predicted mortality; both scores also predicted prolonged stay.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The Modified TTSS, incorporating BMI and GCS, improves early risk stratification\u2014particularly in polytrauma\u2014and may support triage and resource allocation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ejcts\/ezaf480","type":"journal-article","created":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T13:05:24Z","timestamp":1766149524000},"source":"Crossref","is-referenced-by-count":0,"title":["Evaluation and Proposed Refinement of the Thoracic Trauma Severity Score: Improving Prognostic Accuracy in Blunt Chest Trauma Including Polytrauma Patients"],"prefix":"10.1093","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-8419-4733","authenticated-orcid":false,"given":"Noha Mohamed Ashraf","family":"Fouda","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic Surgery, Faculty of Medicine, Mansoura University , Mansoura, 35516,","place":["Egypt"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nour El-Din Noaman","family":"Gwely","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Faculty of Medicine, Mansoura University , Mansoura, 35516,","place":["Egypt"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gehad Ibrahim","family":"Awad","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Faculty of Medicine, Mansoura University , Mansoura, 35516,","place":["Egypt"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammed Abdelfattah","family":"Sanad","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Faculty of Medicine, Mansoura University , Mansoura, 35516,","place":["Egypt"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,12,19]]},"reference":[{"key":"2026010610230754600_ezaf480-B1","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1093\/ejcts\/ezt678","article-title":"Blunt chest trauma: an overview","volume":"46","author":"Kouritas","year":"2014","journal-title":"Eur J Cardiothorac Surg"},{"key":"2026010610230754600_ezaf480-B2","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/j.injury.2011.01.004","article-title":"Risk factors that predict mortality in patients with blunt chest wall trauma: a systematic review and meta-analysis","volume":"43","author":"Battle","year":"2012","journal-title":"Injury"},{"key":"2026010610230754600_ezaf480-B3","doi-asserted-by":"publisher","first-page":"717","DOI":"10.1016\/j.surg.2005.07.022","article-title":"Half-a-dozen ribs: the breakpoint for mortality","volume":"138","author":"Flagel","year":"2005","journal-title":"Surgery"},{"key":"2026010610230754600_ezaf480-B4","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1016\/j.thorsurg.2008.08.003","article-title":"Blunt chest trauma: flail chest, pulmonary contusion, and blast injury","volume":"19","author":"de Moya","year":"2009","journal-title":"Thorac Surg Clin"},{"key":"2026010610230754600_ezaf480-B5","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1007\/s12055-021-01224-2","article-title":"Thorax trauma severity score in patient with chest trauma: study at tertiary-level hospital","volume":"38","author":"Kanake","year":"2022","journal-title":"Indian J Thorac Cardiovasc Surg"},{"key":"2026010610230754600_ezaf480-B6","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1097\/00005373-197403000-00001","article-title":"The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care","volume":"14","author":"Baker","year":"1974","journal-title":"J Trauma"},{"volume-title":"Abbreviated Injury Scale 2005: Update 2008","year":"2008","author":"Gennarelli","key":"2026010610230754600_ezaf480-B7"},{"key":"2026010610230754600_ezaf480-B8","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1097\/00005373-200009000-00011","article-title":"Appraisal of early evaluation of blunt chest trauma: development of a standardized scoring system for initial clinical decision-making","volume":"49","author":"Pape","year":"2000","journal-title":"J Trauma"},{"key":"2026010610230754600_ezaf480-B9","doi-asserted-by":"publisher","first-page":"873","DOI":"10.1016\/j.ejcts.2004.01.046","article-title":"Thoracic trauma severity score predicts outcome after thoracic trauma","volume":"25","author":"Misthos","year":"2004","journal-title":"Eur J Cardiothorac Surg"},{"key":"2026010610230754600_ezaf480-B10","doi-asserted-by":"publisher","first-page":"665","DOI":"10.1016\/S0020-1383(01)00073-9","article-title":"Prognostic value of the thoracic trauma severity score in thoracic trauma","volume":"32","author":"Pape","year":"2001","journal-title":"Injury"},{"key":"2026010610230754600_ezaf480-B11","first-page":"509","volume-title":"Trauma","author":"Livingston","year":"2004","edition":"5th"},{"key":"2026010610230754600_ezaf480-B12","doi-asserted-by":"publisher","first-page":"1426","DOI":"10.1016\/j.injury.2014.02.011","article-title":"Predicting outcomes after blunt chest wall trauma: validation of existing scoring systems","volume":"45","author":"Battle","year":"2014","journal-title":"Injury"},{"key":"2026010610230754600_ezaf480-B13","doi-asserted-by":"publisher","first-page":"653","DOI":"10.1007\/s00068-014-0411-5","article-title":"Predictors of poor outcomes after significant chest trauma in multiply injured patients: a retrospective analysis from the German trauma registry","volume":"40","author":"Huber","year":"2014","journal-title":"Eur J Trauma Emerg Surg"},{"key":"2026010610230754600_ezaf480-B14","doi-asserted-by":"publisher","first-page":"476","DOI":"10.1186\/s13054-014-0476-2","article-title":"Update of the trauma risk adjustment model of the TraumaRegister DGU\u2122: the revised injury severity classification, version II","volume":"18","author":"Lefering","year":"2014","journal-title":"Crit Care"},{"key":"2026010610230754600_ezaf480-B15","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1007\/s00068-012-0255-5","article-title":"Clinical presentation and time-based mortality in patients with chest injuries: a 5-year experience from a level I trauma center","volume":"39","author":"El-Menyar","year":"2013","journal-title":"Eur J Trauma Emerg Surg"},{"key":"2026010610230754600_ezaf480-B16","doi-asserted-by":"publisher","first-page":"673","DOI":"10.1007\/s00068-019-01135-x","article-title":"Trauma scoring systems: state of the art and future directions","volume":"45","author":"Lefering","year":"2019","journal-title":"Eur J Trauma Emerg Surg"},{"key":"2026010610230754600_ezaf480-B17","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1186\/s12873-024-01107-6","article-title":"Prognostic models for blunt chest trauma: a systematic review","volume":"24","author":"Cowell","year":"2024","journal-title":"BMC Emerg Med"},{"key":"2026010610230754600_ezaf480-B18","doi-asserted-by":"publisher","first-page":"10221","DOI":"10.1038\/s41598-023-36679-z","article-title":"Development and validation of a prognostic nomogram for blunt chest trauma patients","volume":"13","author":"Zhao","year":"2023","journal-title":"Sci Rep"},{"key":"2026010610230754600_ezaf480-B19","first-page":"23","article-title":"The accuracy of the thoracic trauma severity score to predict mortality in blunt chest trauma patients","volume":"2","author":"Aulia","year":"2025","journal-title":"Sriwijaya J Surg"},{"key":"2026010610230754600_ezaf480-B20","doi-asserted-by":"publisher","first-page":"2191","DOI":"10.1001\/jama.2013.281053","article-title":"World medical association declaration of helsinki: ethical principles for medical research involving human subjects","volume":"310","author":"World Medical Association","year":"2013","journal-title":"JAMA"},{"key":"2026010610230754600_ezaf480-B21","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1007\/s00068-013-0323-3","article-title":"Update on the definition of polytrauma","volume":"40","author":"Butcher","year":"2014","journal-title":"Eur J Trauma Emerg Surg"},{"volume-title":"Advanced Trauma Life Support (ATLS\u00ae): Student Course Manual","year":"2018","edition":"10th","key":"2026010610230754600_ezaf480-B22"},{"key":"2026010610230754600_ezaf480-B23","doi-asserted-by":"publisher","first-page":"837","DOI":"10.2307\/2531595","article-title":"Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach","volume":"44","author":"DeLong","year":"1988","journal-title":"Biometrics"},{"key":"2026010610230754600_ezaf480-B24","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1016\/S1010-7940(00)00388-7","article-title":"Thoracic trauma severity score: a new scoring system for predicting mortality in patients with blunt chest trauma","volume":"17","author":"Pape","year":"2000","journal-title":"Eur J Cardiothorac Surg"},{"key":"2026010610230754600_ezaf480-B25","doi-asserted-by":"publisher","first-page":"e8317","DOI":"10.1097\/MD.0000000000008317","article-title":"The thorax trauma severity score and the trauma and injury severity score: do they predict in-hospital mortality in patients with severe thoracic trauma?","volume":"96","author":"Moon","year":"2017","journal-title":"Medicine (Baltimore"},{"key":"2026010610230754600_ezaf480-B26","doi-asserted-by":"publisher","first-page":"114","DOI":"10.20408\/jti.2023.0087","article-title":"Validation of chest trauma scoring systems in polytrauma: a retrospective study with 1,038 patients in Korea","volume":"37","author":"Kim","year":"2024","journal-title":"J Trauma Inj"},{"key":"2026010610230754600_ezaf480-B27","doi-asserted-by":"publisher","first-page":"1526","DOI":"10.18203\/2349-2902.isj20201863","article-title":"A study to validate thoracic trauma severity score in chest trauma patients","volume":"7","author":"Sharma","year":"2020","journal-title":"Int Surg J"},{"key":"2026010610230754600_ezaf480-B28","doi-asserted-by":"publisher","first-page":"689","DOI":"10.4187\/respcare.04644","article-title":"What\u2019s next after ARDS: long-term outcomes","volume":"61","author":"Chiumello","year":"2016","journal-title":"Respir Care"},{"key":"2026010610230754600_ezaf480-B29","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1186\/1741-7015-4-38","article-title":"Systematic review of prognostic models in traumatic brain injury","volume":"6","author":"Perel","year":"2006","journal-title":"BMC Med Inform Decis Mak"},{"key":"2026010610230754600_ezaf480-B30","doi-asserted-by":"publisher","first-page":"100","DOI":"10.5455\/ijsm.chesttrauma","article-title":"Evaluation of thoracic trauma severity score in predicting the outcome of isolated blunt chest trauma patients","volume":"2","author":"Elbaih","year":"2016","journal-title":"IJSM"},{"key":"2026010610230754600_ezaf480-B31","doi-asserted-by":"publisher","first-page":"112","DOI":"10.4103\/roaic.roaic_15_21","article-title":"Thorax trauma severity score and trauma injury severity score evaluation as outcome predictors in chest trauma","volume":"9","author":"El-Aziz","year":"2022","journal-title":"Res Opin Anesth Intensive Care"},{"key":"2026010610230754600_ezaf480-B32","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1186\/1749-7922-8-23","article-title":"Thoracic trauma: analysis of 1142 patients","volume":"8","author":"\u00c7ak\u0131r","year":"2013","journal-title":"World J Emerg Surg"}],"container-title":["European Journal of Cardio-Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ejcts\/advance-article-pdf\/doi\/10.1093\/ejcts\/ezaf480\/66033358\/ezaf480.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/68\/1\/ezaf480\/66033358\/ezaf480.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/68\/1\/ezaf480\/66033358\/ezaf480.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T15:32:08Z","timestamp":1767713528000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejcts\/article\/doi\/10.1093\/ejcts\/ezaf480\/8384243"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,19]]},"references-count":32,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1,6]]}},"URL":"https:\/\/doi.org\/10.1093\/ejcts\/ezaf480","relation":{},"ISSN":["1010-7940","1873-734X"],"issn-type":[{"type":"print","value":"1010-7940"},{"type":"electronic","value":"1873-734X"}],"subject":[],"published-other":{"date-parts":[[2026,1]]},"published":{"date-parts":[[2025,12,19]]},"article-number":"ezaf480"}}