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The development and validation of a prognostic model that assists in the management of blunt chest wall trauma patients. / Ceri Elisabeth Battle

Swansea University Author: Ceri Elisabeth Battle

Abstract

Introduction: The difficulties in the management of the blunt chest wall trauma patient in the Emergency Department due to the development o f late complications are well recognised in the literature. The first aim o f this study was to investigate the risk factors for the development o f complicati...

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Published: 2013
Institution: Swansea University
Degree level: Doctoral
Degree name: Ph.D
URI: https://cronfa.swan.ac.uk/Record/cronfa43035
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first_indexed 2018-08-02T18:56:08Z
last_indexed 2019-10-21T16:48:54Z
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spelling 2018-08-29T14:16:42.9984313 v2 43035 2018-08-02 The development and validation of a prognostic model that assists in the management of blunt chest wall trauma patients. 6d0f2db7032a4285a5fbaa038412a3d1 NULL Ceri Elisabeth Battle Ceri Elisabeth Battle true true 2018-08-02 Introduction: The difficulties in the management of the blunt chest wall trauma patient in the Emergency Department due to the development o f late complications are well recognised in the literature. The first aim o f this study was to investigate the risk factors for the development o f complications following blunt chest wall trauma. Using these risk factors, the second aim was to develop and validate a prognostic model that can be used to assist in the management o f this patient group.M ethods: The risk factors for the development o f late complications following blunt chest wall trauma were investigated using a number of methodologies. These included a systematic review and meta-analysis, a questionnaire study and a retrospective observational study. Following identification o f the risk factors, a prognostic model was developed using multivariable logistic regression. This model was then externally validated in a prospective multi-centre study.Results: The systematic review, questionnaire study, retrospective study and development study results highlighted that the risk factors for the development of complications following blunt chest wall trauma were an increasing patient age, the existence o f chronic lung disease, an increasing number of rib fractures, the use of pre-injury anti-coagulants and a decreasing oxygen saturation level on presentation to the Emergency Department. These risk factors were included in the final model. Results of the validation study indicated an overall model accuracy o f 87%, a sensitivity of 75% and a specificity o f 97%. A concordance index o f 0.96 highlighted an excellent discriminatory ability o f the model.Conclusions: The prognostic model developed in this study demonstrated good predictive capabilities in the derivation sample and excellent discrimination in the validation sample. The model demonstrates clinical usefulness as it includes risk factors not normally considered in the management o f blunt chest wall trauma patients in the clinical setting. E-Thesis Trauma patients 31 12 2013 2013-12-31 COLLEGE NANME Swansea University Medical School COLLEGE CODE Swansea University Doctoral Ph.D 2018-08-29T14:16:42.9984313 2018-08-02T16:24:31.1318014 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Ceri Elisabeth Battle NULL 1 0043035-02082018162541.pdf 10821425.pdf 2018-08-02T16:25:41.5500000 Output 23162709 application/pdf E-Thesis true 2018-08-02T16:25:41.5500000 false
title The development and validation of a prognostic model that assists in the management of blunt chest wall trauma patients.
spellingShingle The development and validation of a prognostic model that assists in the management of blunt chest wall trauma patients.
Ceri Elisabeth Battle
title_short The development and validation of a prognostic model that assists in the management of blunt chest wall trauma patients.
title_full The development and validation of a prognostic model that assists in the management of blunt chest wall trauma patients.
title_fullStr The development and validation of a prognostic model that assists in the management of blunt chest wall trauma patients.
title_full_unstemmed The development and validation of a prognostic model that assists in the management of blunt chest wall trauma patients.
title_sort The development and validation of a prognostic model that assists in the management of blunt chest wall trauma patients.
author_id_str_mv 6d0f2db7032a4285a5fbaa038412a3d1
author_id_fullname_str_mv 6d0f2db7032a4285a5fbaa038412a3d1_***_Ceri Elisabeth Battle
author Ceri Elisabeth Battle
author2 Ceri Elisabeth Battle
format E-Thesis
publishDate 2013
institution Swansea University
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
document_store_str 1
active_str 0
description Introduction: The difficulties in the management of the blunt chest wall trauma patient in the Emergency Department due to the development o f late complications are well recognised in the literature. The first aim o f this study was to investigate the risk factors for the development o f complications following blunt chest wall trauma. Using these risk factors, the second aim was to develop and validate a prognostic model that can be used to assist in the management o f this patient group.M ethods: The risk factors for the development o f late complications following blunt chest wall trauma were investigated using a number of methodologies. These included a systematic review and meta-analysis, a questionnaire study and a retrospective observational study. Following identification o f the risk factors, a prognostic model was developed using multivariable logistic regression. This model was then externally validated in a prospective multi-centre study.Results: The systematic review, questionnaire study, retrospective study and development study results highlighted that the risk factors for the development of complications following blunt chest wall trauma were an increasing patient age, the existence o f chronic lung disease, an increasing number of rib fractures, the use of pre-injury anti-coagulants and a decreasing oxygen saturation level on presentation to the Emergency Department. These risk factors were included in the final model. Results of the validation study indicated an overall model accuracy o f 87%, a sensitivity of 75% and a specificity o f 97%. A concordance index o f 0.96 highlighted an excellent discriminatory ability o f the model.Conclusions: The prognostic model developed in this study demonstrated good predictive capabilities in the derivation sample and excellent discrimination in the validation sample. The model demonstrates clinical usefulness as it includes risk factors not normally considered in the management o f blunt chest wall trauma patients in the clinical setting.
published_date 2013-12-31T03:54:08Z
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score 11.037603

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