Use of Thoracic Trauma Severity Score (TTSS) Components and Systems in Predicting Mortality in Thoracic Trauma

Authors

  • Reynaldy C. Moksidy Departemen Bedah Umum, Fakultas Kedokteran, Universitas Sam Ratulangi, Manado, Sulawesi Selatan, Indonesia
  • Adrian Tangkilisan Departemen Bedah Toraks dan Kardiovaskular, Fakultas Kedokteran, Universitas Sam Ratulangi, Manado, Sulawesi Selatan, Indonesia
  • Wega Sukanto Departemen Bedah Toraks dan Kardiovaskular, Fakultas Kedokteran, Universitas Sam Ratulangi, Manado, Sulawesi Selatan, Indonesia

DOI:

https://doi.org/10.51601/ijhp.v6i3.664

Abstract

Thoracic trauma contributes significantly to global mortality, necessitating early risk stratification to guide management. The Thoracic Trauma Severity Score (TTSS) integrates anatomical and physiological parameters to predict outcomes, but validation data from Southeast Asian populations remain limited. This retrospective cohort study included 77 thoracic trauma patients admitted to Prof. Dr. R.D. Kandou General Hospital, Manado, between 2021–2023. TTSS was calculated based on age, PaO₂/FiO₂ ratio, rib fracture count, pulmonary contusion, and pleural involvement. The primary outcome was in-hospital mortality. Statistical analyses included bivariate comparisons, Kaplan–Meier survival analysis, and receiver operating characteristic (ROC) curve analysis.  Overall mortality was 29.9%. Non-survivors had significantly higher TTSS values than survivors (median 5 vs. 2.5, p < 0.001). Patients requiring ICU admission also demonstrated higher TTSS (median 6 vs. 3, p = 0.002). Pulmonary contusion (p = 0.021), PaO₂/FiO₂ ≤400 (p = 0.018), and age >30 years (p = 0.011) were significantly associated with mortality. ROC analysis showed good discriminatory ability for mortality (AUC ≈ 0.80, sensitivity 91%, specificity 50%). TTSS is a practical and effective tool for early mortality risk stratification in thoracic trauma patients, with good predictive performance. Its application in resource-limited settings may facilitate timely triage and escalation of care.

Downloads

Download data is not yet available.

References

[1] A. Jain and M. Waseem, Thoracic Trauma. StatPearls [Internet]: StatPearls Publishing, 2026. [Online]. Available: https://www.ncbi.nlm.nih.gov/books/NBK482194/

[2] D. Helsloot, M. C. Fitzgerald, R. Lefering, S. Verelst, and C. Missant, “The First Hour of Trauma Reception is Critical For Patients with Major Thoracic Trauma,” Eur. J. Anaesthesiol., vol. 40, no. 11, pp. 865–873, 2023, doi: 10.1097/EJA.0000000000001834.

[3] A. Lundin, S. K. Akram, L. Berg, K. E. Göransson, and A. Enocson, “Thoracic Injuries in Trauma Patients: Epidemiology and its Influence on Mortality,” Scand. J. Trauma. Resusc. Emerg. Med., vol. 30, no. 1, p. 69, 2022, doi: 10.1186/s13049-022-01058-6.

[4] A. Benhamed et al., “Road Traffic Accident-Related Thoracic Trauma: Epidemiology, Injury Pattern, Outcome, and Impact on Mortality—A Multicenter Observational Study,” PLoS One, vol. 17, no. 5, p. e0268202, 2022, doi: 10.1371/journal.pone.0268202.

[5] S. Shandilya et al., “A Prospective Observational Study on the Outcome Assessment of Conservative Management Versus Intercostal Drainage (ICD) in Blunt Chest Injury Patients With ≤3 Rib Fractures in a North Indian Tertiary Care Center,” Cureus, vol. 15, no. 7, p. e42167, 2023, doi: 10.7759/cureus.42167.

[6] A. R. Khamees et al., “Comparison of the Thoracic Trauma Severity Score (TTSS) and Trauma and Injury Severity Score (TRISS) in predicting clinical outcomes in chest trauma patients: protocol for a prospective cohort study from Iraq,” Int. J. Surg. Protoc., vol. 29, no. 4, pp. 167–175, 2025, doi: 10.1097/SP9.0000000000000060.

[7] S. Féray et al., “Surgical and Perioperative Management of Flail Chest with Titanium Plates: A French Cohort Series From A Thoracic Referral Center,” J. Cardiothorac. Surg., vol. 18, no. 1, p. 37, Jan. 2023, doi: 10.1186/s13019-023-02121-8.

[8] Lord Mvoula, J. Skubic, D. Weaver, and M. Betancourt-Garcia, “Morbidity and Mortality After Rib Fracture in Elderly Patients (65 Years Old) Compared to a Younger Cohort (≤65 Years of Age) at Doctor Hospital Renaissance Health,” Cureus, vol. 14, no. 10, p. e30941, 2022, doi: 10.7759/cureus.30941.

[9] J. Tachino et al., “Effects of Concomitant Traumatic Spinal Cord and Brain Injury on in-Hospital Mortality: A Retrospective Analysis of a Nationwide Trauma Registry in Japan,” J. Neurotrauma, vol. 41, no. 17–18, pp. 2101–2113, 2024, doi: 10.1089/neu.2024.0168.

[10] M. F. Garcia et al., “Comparison Between Injury Severity Score (ISS) and New Injury Severity Score (NISS) in Predicting Mortality of Thoracic Trauma in A Tertiary Hospital,” Rev. Col. Bras. Cir., vol. 51, p. e20243652, 2024, doi: 10.1590/0100-6991e-20243652-en.

[11] M. R. Zahran, A. A. E. M. A. Elwahab, M. M. A. El Nasr, and M. A. El Heniedy, “Evaluation of The Predictive Value of Thorax Trauma Severity Score (TTSS) in Thoracic-Traumatized Patients,” Cardiothorac. Surg., vol. 28, no. 1, p. 3, 2020, doi: 10.1186/s43057-020-0015-7.

[12] V. Kanake, K. Kale, S. Mangam, and V. Bhalavi, “Thorax Trauma Severity Score in Patient with Chest Trauma: Study at Tertiary-Level Hospital,” Indian J. Thorac. Cardiovasc. Surg., vol. 38, no. 2, pp. 149–156, 2022, doi: 10.1007/s12055-021-01312-z.

[13] S. Choudhary, D. Pasrija, and M. D. Mendez, Pulmonary Contusion. StatPearls [Internet]: StatPearls Publishing, 2024. doi: Pulmonary Contusion.

[14] H. S. Chau, P. M. Gutkin, A. W. Knight, and J. D. Forrester, “Contemporary Management of Pulmonary Contusions: A Narrative Review,” Curr. Challenges Thorac. Surg., vol. 7, pp. 26–26, 2025, doi: 10.21037/ccts-25-18.

[15] L. A. Kahar, “Challenges in the Management of Pulmonary Contusion with Multiple Rib Fractures and Associated Injuries: A Case Report,” Biosci. Med. J. Biomed. Transl. Res., vol. 8, no. 12, pp. 5814–5826, 2024, doi: 10.37275/bsm.v8i12.1155.

Downloads

Published

2026-07-06

How to Cite

Reynaldy C. Moksidy, Adrian Tangkilisan, & Wega Sukanto. (2026). Use of Thoracic Trauma Severity Score (TTSS) Components and Systems in Predicting Mortality in Thoracic Trauma. International Journal of Health and Pharmaceutical (IJHP), 6(3), 513–520. https://doi.org/10.51601/ijhp.v6i3.664

Issue

Section

Articles