{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T14:16:16Z","timestamp":1785420976605,"version":"3.56.0"},"reference-count":25,"publisher":"AOSIS","issue":"1","license":[{"start":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T00:00:00Z","timestamp":1772755200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Background:\u00a0Blunt chest trauma (BCT) is a frequent manifestation of traumatic injury, either as isolated thoracic injury or in the setting of polytrauma.\nObjectives:\u00a0Several chest trauma scores (CTSs) exist based on clinical, biochemical and imaging findings to assist in the risk stratification of patients who have sustained blunt chest trauma. These injuries are often not initially clinically evident and a risk stratification tool serves to identify patients at risk for pulmonary compromise and to establish early diagnostic and therapeutic strategies to improve morbidity and mortality.\nMethod:\u00a0Patient data were obtained from the Greys Hospital Emergency Department\u2019s triage books. The images for patients within the study sample were scored under the categories of age, number of rib fractures, bilaterality of rib fractures, presence and significance of pulmonary contusions, and pleural-based injury. Patients were classified as either critical or non-critical using final disposition as a surrogate. The seminal CTS was initially calculated, following which a novel South African chest trauma score (SA-CTS) was hypothesised and computed based on the chest X-ray alone for ease of applicability and reproducibility in resource-constrained settings.\nResults:\u00a0A conventional CTS \u2265 5 was clinically significant for a critical outcome. However, with the SA-CTS, a score \u2265 4 was found to be statistically significant. Age was not found to be a significant contributing factor. Pleural-based injuries were found to be contributory factors to a critical outcome.\nConclusion:\u00a0Clinical prediction models serve in the risk stratification and early identification and pre-emptive management of patients at high risk for clinical decompensation. Based on the results, the incorporation of the SA-CTS into daily practice in the management of BCT patients is proposed.\nContribution:\u00a0This will prove especially useful in triggering early up-referral for both advanced imaging and tertiary level care in a resource limited setting.<\/jats:p>","DOI":"10.4102\/sajr.v30i1.3344","type":"journal-article","created":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T06:30:14Z","timestamp":1772605814000},"update-policy":"https:\/\/doi.org\/10.4102\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Chest In Time: Investigating the utility of a novel X-ray based blunt chest trauma clinical prediction model in a resource-limited setting in South Africa"],"prefix":"10.4102","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5651-9766","authenticated-orcid":false,"given":"Avika","family":"Kalideen","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04qzfn040","id-type":"ROR","asserted-by":"publisher"}],"name":"University of KwaZulu-Natal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2023-6750","authenticated-orcid":false,"given":"Tanusha","family":"Sewchuran","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04qzfn040","id-type":"ROR","asserted-by":"publisher"}],"name":"University of KwaZulu-Natal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2580","published-online":{"date-parts":[[2026,3,6]]},"reference":[{"key":"ref0","doi-asserted-by":"crossref","unstructured":"Adal O, Tareke AA, Bogale EK, et al. Mortality of traumatic chest injury and its predictors across sub-saharan Africa: Systematic review and meta-analysis, 2024. BMC Emerg Med. 2024;24(1):32. https:\/\/doi.org\/10.1186\/s12873-024-00951-w","DOI":"10.1186\/s12873-024-00951-w"},{"key":"ref1","doi-asserted-by":"crossref","unstructured":"Hildebrand F, Van Griensven M, Garapati R, Krettek C, Pape H-C. Diagnostics and scoring in blunt chest trauma. Eur J Trauma. 2002;28(3):157\u2013167. https:\/\/doi.org\/10.1007\/s00068-002-1192-1","DOI":"10.1007\/s00068-002-1192-1"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Battle CE, Hutchings H, Lovett S, et al. Predicting outcomes after blunt chest wall trauma: Development and external validation of a new prognostic model. Crit Care. 2014;18(3):R98. https:\/\/doi.org\/10.1186\/cc13873","DOI":"10.1186\/cc13873"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"Dogrul BN, Kiliccalan I, Asci ES, Peker SC. Blunt trauma related chest wall and pulmonary injuries: An overview. Chin J Traumatol. 2020;23(3):125\u2013138. https:\/\/doi.org\/10.1016\/j.cjtee.2020.04.003","DOI":"10.1016\/j.cjtee.2020.04.003"},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"Eghbalzadeh K, Sabashnikov A, Zeriouh M, et al. Blunt chest trauma: A clinical chameleon. Heart. 2018;104(9):719\u2013724. https:\/\/doi.org\/10.1136\/heartjnl-2017-312111","DOI":"10.1136\/heartjnl-2017-312111"},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"Rossiter ND. Trauma-the forgotten pandemic? Int Orthop. 2022;46(1):3\u201311. https:\/\/doi.org\/10.1007\/s00264-021-05213-z","DOI":"10.1007\/s00264-021-05213-z"},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"Battle C, Cole E, Carter K, Baker E. Clinical prediction models for the management of blunt chest trauma in the emergency department: A systematic review. BMC Emerg Med. 2024;24(1):189. https:\/\/doi.org\/10.1186\/s12873-024-01107-6","DOI":"10.1186\/s12873-024-01107-6"},{"key":"ref7","unstructured":"Hardcastle TC, Oosthuizen GV, Clarke DL, Lutge E. Trauma, a preventable burden of disease in South Africa: Review of the evidence, with a focus on KwaZulu-Natal. S Afr Health Rev. 2016;2016:179\u2013189."},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"Tefera A, Lutge EE, Moodley N, et al. Tracking the trauma epidemic in KwaZulu-Natal, South Africa. World J Surg. 2023;47(8):1940\u20131945. https:\/\/doi.org\/10.1007\/s00268-023-07032-2","DOI":"10.1007\/s00268-023-07032-2"},{"key":"ref9","doi-asserted-by":"crossref","unstructured":"Pressley CM, Fry WR, Philp AS, Berry SD, Smith RS. Predicting outcome of patients with chest wall injury. Am J Surg. 2012;204(6):910\u2013913; discussion 3\u20134. https:\/\/doi.org\/10.1016\/j.amjsurg.2012.05.015","DOI":"10.1016\/j.amjsurg.2012.05.015"},{"key":"ref10","doi-asserted-by":"crossref","unstructured":"Chen J, Jeremitsky E, Philp F, Fry W, Smith RS. A chest trauma scoring system to predict outcomes. Surgery. 2014;156(4):988\u2013993. https:\/\/doi.org\/10.1016\/j.surg.2014.06.045","DOI":"10.1016\/j.surg.2014.06.045"},{"key":"ref11","doi-asserted-by":"crossref","unstructured":"Harde M, Aditya G, Dave S. Prediction of outcomes in chest trauma patients using chest trauma scoring system: A prospective observational study. Indian J Anaesth. 2019;63(3):194\u2013199. https:\/\/doi.org\/10.4103\/ija.IJA_750_18","DOI":"10.4103\/ija.IJA_750_18"},{"key":"ref12","doi-asserted-by":"crossref","unstructured":"Elsaied Hussein MH, Fadl Mahmoud I, Ms Eita Y, et al. A Prospective study of chest trauma Scoring system as a morbidity and mortality predictor in patients with blunt chest trauma. Med J Islam Repub Iran. 2024;38:4. https:\/\/doi.org\/10.47176\/mjiri.38.4","DOI":"10.47176\/mjiri.38.4"},{"key":"ref13","doi-asserted-by":"crossref","unstructured":"Pape HC, Remmers D, Rice J, Ebisch M, Krettek C, Tscherne H. Appraisal of early evaluation of blunt chest trauma: Development of a standardized scoring system for initial clinical decision making. J Trauma. 2000;49(3):496\u2013504. https:\/\/doi.org\/10.1097\/00005373-200009000-00018","DOI":"10.1097\/00005373-200009000-00018"},{"key":"ref14","doi-asserted-by":"crossref","unstructured":"Chapman BC, Herbert B, Rodil M, et al. RibScore: A novel radiographic score based on fracture pattern that predicts pneumonia, respiratory failure, and tracheostomy. J Trauma Acute Care Surg. 2016;80(1):95\u2013101. https:\/\/doi.org\/10.1097\/TA.0000000000000867","DOI":"10.1097\/TA.0000000000000867"},{"key":"ref15","doi-asserted-by":"crossref","unstructured":"Battle C, Cole E, Whelan R, Baker E. Scoping review of the literature to ascertain how the STUMBL Score clinical prediction model is used to manage patients with blunt chest wall trauma in emergency care. Injury. 2023;54(7):110796. https:\/\/doi.org\/10.1016\/j.injury.2023.05.027","DOI":"10.1016\/j.injury.2023.05.027"},{"key":"ref16","doi-asserted-by":"crossref","unstructured":"Callisto E, Costantino G, Tabner A, Kerslake D, Reed MJ. The clinical effectiveness of the STUMBL score for the management of ED patients with blunt chest trauma compared to clinical evaluation alone. Intern Emerg Med. 2022;17(6):1785\u20131793. https:\/\/doi.org\/10.1007\/s11739-022-03001-0","DOI":"10.1007\/s11739-022-03001-0"},{"key":"ref17","doi-asserted-by":"crossref","unstructured":"Kithuka CM, Ntola VC, Sibanda W. An audit of traumatic haemothoraces in a regional hospital in KwaZulu-Natal, South Africa. S Afr J Surg. 2023;61(3):12\u201316. https:\/\/doi.org\/10.36303\/SAJS.3986","DOI":"10.36303\/SAJS.3986"},{"key":"ref18","doi-asserted-by":"crossref","unstructured":"Dippenaar E, Wallis L. Pre-hospital intercostal chest drains in South Africa: A modified Delphi study. Afr J Emerg Med. 2019;9(2):91\u201395. https:\/\/doi.org\/10.1016\/j.afjem.2019.01.003","DOI":"10.1016\/j.afjem.2019.01.003"},{"key":"#cr-split#-ref19.1","unstructured":"Greys Hospital. Greys Hospital annual report 2022\/2023 [homepage on the Internet]. Pietermaritzburg: KZN Department of Health"},{"key":"#cr-split#-ref19.2","unstructured":"2022\/2023 [cited 2025 Dec 10]. Available from: https:\/\/www2.kznhealth.gov.za\/Greys\/Annual-Report-2022-2023.pdf"},{"key":"ref20","unstructured":"Moodley NB, Clarke DL, Aldous C. Current trauma patterns in Pietermaritzburg. S Afr J Surg. 2015;53(3 and 4):42\u201344."},{"key":"ref21","doi-asserted-by":"crossref","unstructured":"Polireddy K, Hoff C, Kinger NP, Tran A, Maddu K. Blunt thoracic trauma: Role of chest radiography and comparison with CT \u2013 Findings and literature review. Emerg Radiol. 2022;29(4):743\u2013755. https:\/\/doi.org\/10.1007\/s10140-022-02061-1","DOI":"10.1007\/s10140-022-02061-1"},{"key":"ref22","doi-asserted-by":"crossref","unstructured":"Bozorgi F, Assadi T, Sazgar M, Jahanian F, Abdollahifar M, Aminiahidashti H. Trauma outcomes in elderly patients referring to the emergency department via the rapid emergency medicine score, injury severity score, and geriatric trauma outcome score indices. Int J Emerg Med. 2025;18(1):223. https:\/\/doi.org\/10.1186\/s12245-025-01046-4","DOI":"10.1186\/s12245-025-01046-4"},{"key":"ref23","doi-asserted-by":"crossref","unstructured":"Sikander N, Ahmad T, Shaikh KA, Sr., Abid A, Mazcuri M, Nasreen S. Analysis of injury patterns and outcomes of blunt thoracic trauma in elderly patients. 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