Chest TraumaTTSS-IraqNCT06744959
Thorax Trauma Severity Score in Chest Trauma: A Study in Iraq
An observational study of Chest Trauma, run by Al-Nahrain University at 1 site in Iraq.
Trial summary
This prospective observational study aims to evaluate the predictive utility of the Thorax Trauma Severity Score (TTSS) in determining morbidity and mortality in patients presenting with chest trauma at a tertiary hospital in Iraq. Read more about this study
- Who is it for?
- Ages 16 years and older
- Conditions the study is for
- Chest Trauma
- How many people
- 166 participants
- Where
- 1 siteIraq
- Study dates
- 22 Oct 2025to 10 May 2027
- Phase
- Observational
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 16 years and older
- All sexes
- No healthy volunteers
- Child, Adult, Older adult
Study population: The study population includes adult patients aged 16 years and older presenting with chest trauma, including both blunt and penetrating injuries, at the emergency department of a tertiary hospital in Iraq. Participants will be evaluated for injury severity using the Thorax Trauma Severity Score (TTSS), with demographic and clinical data collected to explore outcome predictors. This population represents a diverse cohort reflective of trauma patterns in a resource-limited setting.
Who may be able to join
- patients above 16 years of age.
- Patients presenting to the emergency department with thoracic trauma.
- Patients or their legal guardians must provide informed consent to participate in the study.
Who cannot join
- Patients with incomplete clinical data or those discharged before scoring can be performed.
- Pregnant patients (due to specific physiological considerations not accounted for by the scoring system).
- Patients who succumb to their injuries before scoring or baseline data collection.
- chronic respiratory diseases
- malignancy and end-organ failure
- Patients with severe head injury (having extradural, subdural, subarachnoid, or intraparenchymal hemorrhage and skull bone fracture) or those requiring prior neurosurgical intervention
- patients with severe abdominal injury requiring surgical intervention like laparotomy
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Iraq1 site, 1 recruiting
- Recruiting
College of Medicine - Al-Nahrain University
Baghdad
Luma K Mohammed, MBChB,FIBMS/CM, +964770225676, lumakmohammed@nahrainuniv.edu.iq
Abdulillah R. Khamees Al-Mamoori, MBBCH
About this study
Official title: Reliability of Thoracic Trauma Severity Scores in Predicting Outcomes Among Chest Trauma Patients in Low-Resource Settings: A Prospective Cohort Study From Iraq
This prospective observational study aims to evaluate the predictive utility of the Thorax Trauma Severity Score (TTSS) in determining morbidity and mortality in patients presenting with chest trauma at a tertiary hospital in Iraq. The primary objectives of the study are:
To assess the accuracy of TTSS in predicting mortality and critical outcomes such as ICU admission and the need for advanced interventions.
Read more
To evaluate the utility of TTSS in stratifying patients based on injury severity in a resource-constrained setting.
To identify demographic and clinical factors influencing the predictive performance of TTSS.
Participants will:
Be assessed using the TTSS upon arrival at the emergency department to establish risk stratification.
Provide demographic and clinical data, including age, gender, mechanism of injury, comorbidities, and length of hospital stay, for analyzing associations with clinical outcomes.
Read the detailed description
Chest trauma encompasses a wide range of injuries from small rib fractures to potentially fatal thoracic organ injury, making it a major problem in emergency medicine and trauma care. Common causes of chest trauma include motor vehicle collisions (MVCs), falls, and attacks. After head trauma and abdominal damage, chest trauma is the third most prevalent cause of death for patients with polytrauma and the second most common unintended traumatic injury. Death rates from chest trauma are the highest; in some studies, they can reach 60%. Chest trauma is responsible for 25% of mortality in patients with severe trauma. The main causes of death in these situations are frequently ascribed to hypoxia, severe bleeding, or postponed surgery. As such, prompt diagnosis and careful evaluation of the extent of chest damage are essential for enhancing patient outcomes and reducing morbidity and death.
Correct treatment of thoracic trauma, from anticipating the need for urgent care to addressing potential sequelae, depends on an early and precise assessment of the severity level. The requirement for a precise scale in the assessment of thoracic trauma is highlighted by the fact that no scale now in use can accomplish this. Although frequently used, scales like the Trauma Injury Severity Score (TRISS) and the Injury Severity Score (ISS) are global poly-trauma measures that understate localized thoracic damage. The Lung Injury Scale and the Abbreviated Injury Scale (AIStorax) are two other thoracic measures that only use anatomical results. The presence of three or more rib fractures, especially a fracture of the first rib, has traditionally been thought to be related with increased severity. It is currently unclear how factors like age, the mechanism, and the extent of the injury relate to the emergence of pulmonary problems.
Both anatomical and functional criteria were included in the Thorax Trauma Severity Score (TTSS), which was described by Pape et al. in 2000. Using characteristics accessible during the initial examination, the scale was designed to assist emergency medical evaluation in identifying trauma patients at risk of pulmonary problems. This evaluation could be used in both primary and secondary level hospitals. The ability of this scale to predict death has recently been verified. With a score ranging from 0 to 25 points, the TTSS takes into account five important factors: age, pleural injuries, lung contusions, rib fractures, and the PaO2/FiO2 ratio.
Although the TTSS may be useful, its validity about Iraqi hospitals has not yet been fully assessed. This study attempts to close this gap by evaluating the TTSS's prognostic function in forecasting the outcomes of thoracic trauma at tertiary-level hospitals in Iraq. The study aims to ascertain the efficacy of TTSS in a community context and pinpoint precise cut-off points that could help medical professionals make well-informed choices about patient care and treatment plans.
- Conditions
- Chest Trauma
- Keywords
- TTSS, Chest, Trauma
- Medical subject headings
- Thoracic Injuries, Wounds and Injuries
What is being measured
The primary outcome is the main question the study is designed to answer.
Accuracy Assessment of Thorax trauma severity score (TTSS) in Predicting In-Hospital Mortality
The total score ranges from 0 to 25, with higher scores indicating more severe injuries, a poorer prognosis, and an increased risk of in-hospital mortality.
Measured: From admission to hospital discharge or death, up to 30 days
Secondary outcomes (4)
Accuracy Assessment of the Thorax Trauma Severity Score (TTSS) in Predicting the Need for ICU Admission
The TTSS ranges from 0 to 25, with higher scores reflecting more severe thoracic injuries. This outcome evaluates the score's ability to predict the requirement for ICU admission in trauma patients, with higher TTSS values expected to correlate with increased likelihood of ICU admission.
Measured: From emergency department admission to ICU admission, hospital discharge, or in-hospital death (up to 30 days).
Accuracy Assessment of the Thorax Trauma Severity Score (TTSS) in Predicting Early Hospital Discharge
This outcome evaluates the ability of the TTSS (ranging from 0 to 25) to predict early hospital discharge in thoracic trauma patients. Lower TTSS values are hypothesized to be associated with a higher likelihood of early discharge, reflecting less severe injury.
Measured: From hospital admission to discharge, within 72 hours (early discharge).
Accuracy Assessment of the Thorax Trauma Severity Score (TTSS) in Predicting the Need for Surgical Intervention
This outcome measures the predictive accuracy of the TTSS range (from 0 to 25) in identifying patients who require surgical management (e.g., thoracotomy, VATS, or chest wall repair) due to thoracic trauma. Higher TTSS values are expected to correlate with an increased likelihood of surgical intervention.
Measured: From emergency department admission to surgical intervention, hospital discharge, or in-hospital death (up to 30 days).
Accuracy Assessment of the Thorax Trauma Severity Score (TTSS) in Predicting In-Hospital Morbidity
This outcome evaluates the incidence and types of complications (morbidity) experienced by patients with thoracic trauma, as predicted by the TTSS range (from 0 to 25). Higher TTSS values are expected to correlate with increased morbidity, including respiratory complications, infections, prolonged mechanical ventilation, and other trauma-related adverse events.
Measured: From hospital admission to discharge or death, up to 30 days.
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted20 Dec 2024
- Study start22 Oct 2025
- Primary completion1 May 2027 (estimated)
- Study completion10 May 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (10)Papers the sponsor has linked to this study.
- Other trials for Chest TraumaStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Prospective
- Enrolment
- 166 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Al-Nahrain University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Abdulillah R. Khamees, Al-Nahrain University
- Investigators
- Luma K Mohammed, Assistant professor, Study director, Al-Nahrain University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06744959
- Sponsor's protocol ID
- UNCOMIRB20241212B
- Acronym
- TTSS-Iraq
- Status last verified
- Sep 2026
- First submitted
- 12 Dec 2024
- Last updated
- 17 Sep 2026
- Results posted
- No
- Data monitoring committee
- Yes
- Individual data sharing
- No
Publications
Moore EE, Malangoni MA, Cogbill TH, Shackford SR, Champion HR, Jurkovich GJ, McAninch JW, Trafton PG. Organ injury scaling. IV: Thoracic vascular, lung, cardiac, and diaphragm. J Trauma. 1994 Mar;36(3):299-300. No abstract available.
PubMed 8145307Rating the severity of tissue damage. I. The abbreviated scale. JAMA. 1971 Jan 11;215(2):277-80. doi: 10.1001/jama.1971.03180150059012. No abstract available.
PubMed 5107365Boyd CR, Tolson MA, Copes WS. Evaluating trauma care: the TRISS method. Trauma Score and the Injury Severity Score. J Trauma. 1987 Apr;27(4):370-8.
PubMed 3106646Bozorgi F, Mirabi A, Chabra A, Mirabi R, Hosseininejad S-M, Zaheri H. Mechanisms of traumatic injuries in multiple trauma Patients. Int J Med Invest. 2018;7:7-15
Khandhar SJ, Johnson SB, Calhoon JH. Overview of thoracic trauma in the United States. Thorac Surg Clin. 2007 Feb;17(1):1-9. doi: 10.1016/j.thorsurg.2007.02.004.
PubMed 17650692Aukema TS, Beenen LF, Hietbrink F, Leenen LP. Validation of the Thorax Trauma Severity Score for mortality and its value for the development of acute respiratory distress syndrome. Open Access Emerg Med. 2011 Aug 23;3:49-53. doi: 10.2147/OAEM.S22802. eCollection 2011.
PubMed 27147852Pape 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 Sep;49(3):496-504. doi: 10.1097/00005373-200009000-00018.
PubMed 11003329Wutzler S, Wafaisade A, Maegele M, Laurer H, Geiger EV, Walcher F, Barker J, Lefering R, Marzi I; Trauma Registry of DGU. Lung Organ Failure Score (LOFS): probability of severe pulmonary organ failure after multiple injuries including chest trauma. Injury. 2012 Sep;43(9):1507-12. doi: 10.1016/j.injury.2010.12.029. Epub 2011 Jan 21.
PubMed 21256489Clark GC, Schecter WP, Trunkey DD. Variables affecting outcome in blunt chest trauma: flail chest vs. pulmonary contusion. J Trauma. 1988 Mar;28(3):298-304. doi: 10.1097/00005373-198803000-00004.
PubMed 3351988Chrysou K, Halat G, Hoksch B, Schmid RA, Kocher GJ. Lessons from a large trauma center: impact of blunt chest trauma in polytrauma patients-still a relevant problem? Scand J Trauma Resusc Emerg Med. 2017 Apr 20;25(1):42. doi: 10.1186/s13049-017-0384-y.
PubMed 28427480
Study at a glance
From the registry record, last updated by the sponsor on 17 Sep 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Reliability of Thoracic Trauma Severity Scores in Predicting Outcomes Among Chest Trauma Patients in Low-Resource Settings: A Prospective Cohort Study From Iraq
- ClinicalTrials.gov ID
- NCT06744959
- Acronym / sponsor ID
- TTSS-Iraq / UNCOMIRB20241212B
- Conditions
- Chest Trauma
- Keywords
- TTSS, Chest, Trauma
- Study type
- Observational
- Recruitment status
- Recruiting
- Enrolment
- 166 participants (estimated)
- Lead sponsor
- Al-Nahrain UniversityUniversity, hospital or other
- Study start
- 22 Oct 2025 (actual)
- Primary completion
- 1 May 2027 (estimated)
- Study completion
- 10 May 2027 (estimated)
- First posted
- 20 Dec 2024 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This prospective observational study aims to evaluate the predictive utility of the Thorax Trauma Severity Score (TTSS) in determining morbidity and mortality in patients presenting with chest trauma at a tertiary hospital in Iraq. The primary objectives of the study are:
To assess the accuracy of TTSS in predicting mortality and critical outcomes such as ICU admission and the need for advanced interventions.
To evaluate the utility of TTSS in stratifying patients based on injury severity in a resource-constrained setting.
To identify demographic and clinical factors influencing the predictive performance of TTSS.
Participants will:
Be assessed using the TTSS upon arrival at the emergency department to establish risk stratification.
Provide demographic and clinical data, including age, gender, mechanism of injury, comorbidities, and length of hospital stay, for analyzing associations with clinical outcomes.
Detailed description
Chest trauma encompasses a wide range of injuries from small rib fractures to potentially fatal thoracic organ injury, making it a major problem in emergency medicine and trauma care. Common causes of chest trauma include motor vehicle collisions (MVCs), falls, and attacks. After head trauma and abdominal damage, chest trauma is the third most prevalent cause of death for patients with polytrauma and the second most common unintended traumatic injury. Death rates from chest trauma are the highest; in some studies, they can reach 60%. Chest trauma is responsible for 25% of mortality in patients with severe trauma. The main causes of death in these situations are frequently ascribed to hypoxia, severe bleeding, or postponed surgery. As such, prompt diagnosis and careful evaluation of the extent of chest damage are essential for enhancing patient outcomes and reducing morbidity and death.
Correct treatment of thoracic trauma, from anticipating the need for urgent care to addressing potential sequelae, depends on an early and precise assessment of the severity level. The requirement for a precise scale in the assessment of thoracic trauma is highlighted by the fact that no scale now in use can accomplish this. Although frequently used, scales like the Trauma Injury Severity Score (TRISS) and the Injury Severity Score (ISS) are global poly-trauma measures that understate localized thoracic damage. The Lung Injury Scale and the Abbreviated Injury Scale (AIStorax) are two other thoracic measures that only use anatomical results. The presence of three or more rib fractures, especially a fracture of the first rib, has traditionally been thought to be related with increased severity. It is currently unclear how factors like age, the mechanism, and the extent of the injury relate to the emergence of pulmonary problems.
Both anatomical and functional criteria were included in the Thorax Trauma Severity Score (TTSS), which was described by Pape et al. in 2000. Using characteristics accessible during the initial examination, the scale was designed to assist emergency medical evaluation in identifying trauma patients at risk of pulmonary problems. This evaluation could be used in both primary and secondary level hospitals. The ability of this scale to predict death has recently been verified. With a score ranging from 0 to 25 points, the TTSS takes into account five important factors: age, pleural injuries, lung contusions, rib fractures, and the PaO2/FiO2 ratio.
Although the TTSS may be useful, its validity about Iraqi hospitals has not yet been fully assessed. This study attempts to close this gap by evaluating the TTSS's prognostic function in forecasting the outcomes of thoracic trauma at tertiary-level hospitals in Iraq. The study aims to ascertain the efficacy of TTSS in a community context and pinpoint precise cut-off points that could help medical professionals make well-informed choices about patient care and treatment plans.
Study design
- Observational model
- Cohort
- Time perspective
- Prospective
Who may qualify
- Ages
- 16 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child, Adult, Older adult
- Study population
- The study population includes adult patients aged 16 years and older presenting with chest trauma, including both blunt and penetrating injuries, at the emergency department of a tertiary hospital in Iraq. Participants will be evaluated for injury severity using the Thorax Trauma Severity Score (TTSS), with demographic and clinical data collected to explore outcome predictors. This population represents a diverse cohort reflective of trauma patterns in a resource-limited setting.
Key inclusion criteria (3 listed)
- patients above 16 years of age.
- Patients presenting to the emergency department with thoracic trauma.
- Patients or their legal guardians must provide informed consent to participate in the study.
Key exclusion criteria (7 listed)
- Patients with incomplete clinical data or those discharged before scoring can be performed.
- Pregnant patients (due to specific physiological considerations not accounted for by the scoring system).
- Patients who succumb to their injuries before scoring or baseline data collection.
- chronic respiratory diseases
- malignancy and end-organ failure
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Primary outcome
Accuracy Assessment of Thorax trauma severity score (TTSS) in Predicting In-Hospital Mortality
Time frame: From admission to hospital discharge or death, up to 30 days
The total score ranges from 0 to 25, with higher scores indicating more severe injuries, a poorer prognosis, and an increased risk of in-hospital mortality.
4 secondary outcomes
Accuracy Assessment of the Thorax Trauma Severity Score (TTSS) in Predicting the Need for ICU Admission
Time frame: From emergency department admission to ICU admission, hospital discharge, or in-hospital death (up to 30 days).
Accuracy Assessment of the Thorax Trauma Severity Score (TTSS) in Predicting Early Hospital Discharge
Time frame: From hospital admission to discharge, within 72 hours (early discharge).
Accuracy Assessment of the Thorax Trauma Severity Score (TTSS) in Predicting the Need for Surgical Intervention
Time frame: From emergency department admission to surgical intervention, hospital discharge, or in-hospital death (up to 30 days).
Accuracy Assessment of the Thorax Trauma Severity Score (TTSS) in Predicting In-Hospital Morbidity
Time frame: From hospital admission to discharge or death, up to 30 days.
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 17 Sep 2026.
- Background: PubMed 8145307Moore EE, Malangoni MA, Cogbill TH, Shackford SR, Champion HR, Jurkovich GJ, McAninch JW, Trafton PG. Organ injury scaling. IV: Thoracic vascular, lung, cardiac, and diaphragm. J Trauma. 1994 Mar;36(3):299-300. No abstract available.
- Background: PubMed 5107365Rating the severity of tissue damage. I. The abbreviated scale. JAMA. 1971 Jan 11;215(2):277-80. doi: 10.1001/jama.1971.03180150059012. No abstract available.
- Background: PubMed 3106646Boyd CR, Tolson MA, Copes WS. Evaluating trauma care: the TRISS method. Trauma Score and the Injury Severity Score. J Trauma. 1987 Apr;27(4):370-8.
- BackgroundBozorgi F, Mirabi A, Chabra A, Mirabi R, Hosseininejad S-M, Zaheri H. Mechanisms of traumatic injuries in multiple trauma Patients. Int J Med Invest. 2018;7:7-15
- Background: PubMed 17650692Khandhar SJ, Johnson SB, Calhoon JH. Overview of thoracic trauma in the United States. Thorac Surg Clin. 2007 Feb;17(1):1-9. doi: 10.1016/j.thorsurg.2007.02.004.
- Results publication: PubMed 27147852Aukema TS, Beenen LF, Hietbrink F, Leenen LP. Validation of the Thorax Trauma Severity Score for mortality and its value for the development of acute respiratory distress syndrome. Open Access Emerg Med. 2011 Aug 23;3:49-53. doi: 10.2147/OAEM.S22802. eCollection 2011.
- Results publication: PubMed 11003329Pape 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 Sep;49(3):496-504. doi: 10.1097/00005373-200009000-00018.
- Results publication: PubMed 21256489Wutzler S, Wafaisade A, Maegele M, Laurer H, Geiger EV, Walcher F, Barker J, Lefering R, Marzi I; Trauma Registry of DGU. Lung Organ Failure Score (LOFS): probability of severe pulmonary organ failure after multiple injuries including chest trauma. Injury. 2012 Sep;43(9):1507-12. doi: 10.1016/j.injury.2010.12.029. Epub 2011 Jan 21.
- Results publication: PubMed 3351988Clark GC, Schecter WP, Trunkey DD. Variables affecting outcome in blunt chest trauma: flail chest vs. pulmonary contusion. J Trauma. 1988 Mar;28(3):298-304. doi: 10.1097/00005373-198803000-00004.
- Results publication: PubMed 28427480Chrysou K, Halat G, Hoksch B, Schmid RA, Kocher GJ. Lessons from a large trauma center: impact of blunt chest trauma in polytrauma patients-still a relevant problem? Scand J Trauma Resusc Emerg Med. 2017 Apr 20;25(1):42. doi: 10.1186/s13049-017-0384-y.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Luma K Mohammed, Assistant professor study director
Al-Nahrain University
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Chest Trauma, run by Al-Nahrain University at 1 site in Iraq.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 3 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 17 Sep 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Iraq. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Abdulillah R. Khamees Al-Mamoori, MBBCH (07838571013, allaabed987@ced.nahrainuniv.edu.iq), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Accuracy Assessment of Thorax trauma severity score (TTSS) in Predicting In-Hospital Mortality (time frame: From admission to hospital discharge or death, up to 30 days). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT06744959, which also lists 10 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 17 Sep 2026.