An observational study in Chest Trauma, sponsored by Al-Nahrain University. Recruiting at 1 site in Iraq. Open to participants aged 16 Years and older. Per ClinicalTrials.gov, last updated 2026-03-04.
Sponsored by Al-Nahrain University · Observational
The goal of this observational study is to compare the predictive utility of the Thorax Trauma Severity Score (TTSS) and the Trauma and Injury Severity Score (TRISS) in determining outcomes among patients presenting with chest trauma to the emergency room. The main questions it aims to answer are:
Does the TTSS provide a more accurate prediction of patient outcomes (e.g., mortality, ICU admission) than the TRISS? Are there specific patient subgroups where one score is more effective than the other?
Participants will:
Have their chest trauma severity assessed using both TTSS and TRISS during their emergency room admission.
Have their clinical outcomes (e.g., mortality, ICU admission, length of hospital stay) monitored throughout their hospital stay.
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 .
72 studies on the registry are indexed under Thoracic Injuries; 18 are open to participants now.
This study's planned enrollment of 150 is close to the median of 150 across 32 observational studies indexed under Thoracic Injuries.
Browse Thoracic Injuries studies →Al-Nahrain University is the lead sponsor of 26 studies on the registry; 20 are open to participants now.
Counted across the registry records on this site, refreshed daily.
The study population will consist of adult patients (18 years and older) who present to the Emergency Department (ER) of Al-Kadhimiya Teaching Hospital with chest trauma. This population will be classified based on the severity of their injuries, ranging from minor to critical, and include both blunt and penetrating trauma cases.
Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.
Exclusion Criteria:
Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
Informed consent
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
In hospital mortality
Mortality (death) during hospitalization.
Time frame: In-Hospital Phase (average of 7-10 days through discharge)
Accuracy Assessment of Thorax Trauma Severity Score (TTSS)
Range: from 0 to 25, with higher scores indicating more severe thoracic trauma.
Time frame: the first 6 hours after ER admission
Accuracy Assessment of Trauma and Injury Severity Score (TRISS)
Range: 0 (represents a 0% probability of survival) to 1 (represents a 100% probability of survival), with higher scores indicating greater trauma severity.
Time frame: the first 6 hours after ER admission
Length of Hospitalization
Description: The total duration of a patient's stay in the hospital, measured from the date of admission to the date of discharge. This includes all days spent in general wards, intensive care units (ICU), and other hospital departments as part of their treatment course.
Time frame: Up to discharge, an average of 7-10 days
Rate of admission to the intensive care unit (ICU)
The requirement for admission to the intensive care unit (ICU) is determined by the presence of severe clinical deterioration, significant complications, or the need for advanced monitoring and life-support measures.
Time frame: Up to discharge, an average of 7-10 days
Plan to share: No
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Al-Nahrain University