COMPARISON OF SCORE SYSTEM FOR THE EARLY IDENTIFICATION OF TRAUMATIC HOLLOW VISCUS INJURIES IN AN EMERGENCY DEPARTMENT andrea.mingoli@uniroma1.it

 

COMPARISON OF SCORE SYSTEM FOR THE EARLY IDENTIFICATION OF TRAUMATIC HOLLOW VISCUS INJURIES IN AN EMERGENCY DEPARTMENT

5

Italy

Oral only

Traumatic hollow viscus and mesenteric injuries (HVMI), although uncommon (incidence 1.2% in blunt trauma) are associated with higher morbidity and mortality rates compared to patients with similar Injury Severity Scores (ISS) without HVMI. Diagnostic challenges can cause delayed recognition and treatment. Our study compared the diagnostic performance of 5 scores proposed to improve early identification and risk stratification.

A retrospective analysis of the last 150 patients presenting HVMI admitted to our emergency department was performed with endpoints the comparison the diagnostic accuracy of five scores (BIPS, Faget, RAPTOR, Bonomi and BIMMS) and the identification of the most reliable single predictive parameters. Diagnostic accuracy was evaluated using sensitivity, specificity, predictive values and AUC. Logistic regression was used to identify independent predictors of HVMI diagnosis. Calibration and decision curve analysis were performed to assess model accuracy and clinical utility.

RAPTOR demonstrated the highest discriminative accuracy for predicting the need for therapeutic surgery (AUC 0.83), followed by Bonomi (AUC 0.59), BIMMS (AUC 0.54), and BIPS (AUC 0.48). RAPTOR achieved 74.5% sensitivity and 100% specificity; Bonomi achieved 92.2% sensitivity, 50% specificity but the highest overall accuracy (89%) and lowest number needed to treat (NNT = 1.17).

RAPTOR and Bonomi scores demonstrated the highest diagnostic and clinical utility in identifying patients requiring laparotomy after blunt trauma. RAPTOR showed excellent specificity and no false positive; Bonomi maximized sensitivity and overall accuracy. These findings support the integration of these two radiological scoring systems into clinical algorithms to improve early decision-making and reduce delay in surgical intervention.