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Background <p>Blunt traumatic hollow viscus and mesenteric injury (THVMI) remains a diagnostic challenge. In 2020, our group proposed the Niguarda Score, a simple tool to predict clinically relevant THVMI based on six binary CT findings. This study aimed to evaluate the Niguarda Score and compare its performance with established CT-based and combined THVMI scoring systems.</p> Methods <p>We retrospectively analyzed the data of all consecutive adult patients undergoing contrast-enhanced abdominal CT after blunt trauma at the Niguarda trauma center from 2019 to 2021. All variables constituting the Niguarda, Faget, BIPS, BBMI, and RAPTOR scores were gathered in an electronic dataset. The Z-score was not included due to its complex grading system for abdominal tenderness. Discrimination (Area Under the Curve - AUC), and pairwise AUC comparisons through the DeLong test were performed to test the Niguarda score against the Faget, BIPS, BBMI, and RAPTOR scores.</p> Results <p>Over 3 years, 268 consecutive patients respecting the inclusion criteria were selected. Thirty-two patients (11.9%) underwent surgical exploration, and 11 had surgically relevant THVMI (4.1%). Ninety-four patients were intubated on the field; for them, data regarding abdominal pain/tenderness were not available. In the whole cohort, the Niguarda Scoring model achieved an AUC of 0.87 (95%CI: 0.69–1.00). Other THVMI scores AUCs were: Faget 0.87 (95%CI: 0.7-1.00), BIPS 0.89 (95%CI: 0.77-1.00), BBMI 0.85 (95%CI: 0.71–0.99), RAPTOR 0.72 (95%CI: 0.50–0.95). In the subset of patients for whom clinical data were not available, the AUC was 0.91 (95%CI: 0.81-1.00), 0.87 (95%CI: 0.74–0.99), and 0.75 (95%CI: 0.58–0.91) for the Niguarda, Faget, and RAPTOR scores, respectively. DeLong tests failed to highlight any significant difference with the other scores.</p> Conclusions <p>The Niguarda Score demonstrated excellent discrimination and calibration. Its performance was at least comparable to other established THVMI scoring systems. Its simplicity, reproducibility, and robust accuracy support its integration into clinical workflows for early risk stratification in blunt abdominal trauma. Prospective multicenter studies are warranted to confirm these findings and assess the impact on management.</p>

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Blunt traumatic hollow viscus and mesenteric injuries: a comparison of the currently available scoring systems

  • 期刊论文

  • 发表日期：

    2026年3月9日

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  • Stefano Granieri,
  • Michele Altomare,
  • Ilaria Milanesi,
  • Maria Eugenia Di Sabato,
  • Sophia Costacurta,
  • Giacomo Adami,
  • Carlotta Casale,
  • Gaia Ghilardi,
  • Stefano Piero Bernardo Cioffi,
  • Andrea Spota,
  • Federico Ambrogi,
  • Stefania Cimbanassi

摘要

Background

Blunt traumatic hollow viscus and mesenteric injury (THVMI) remains a diagnostic challenge. In 2020, our group proposed the Niguarda Score, a simple tool to predict clinically relevant THVMI based on six binary CT findings. This study aimed to evaluate the Niguarda Score and compare its performance with established CT-based and combined THVMI scoring systems.

Methods

We retrospectively analyzed the data of all consecutive adult patients undergoing contrast-enhanced abdominal CT after blunt trauma at the Niguarda trauma center from 2019 to 2021. All variables constituting the Niguarda, Faget, BIPS, BBMI, and RAPTOR scores were gathered in an electronic dataset. The Z-score was not included due to its complex grading system for abdominal tenderness. Discrimination (Area Under the Curve - AUC), and pairwise AUC comparisons through the DeLong test were performed to test the Niguarda score against the Faget, BIPS, BBMI, and RAPTOR scores.

Results

Over 3 years, 268 consecutive patients respecting the inclusion criteria were selected. Thirty-two patients (11.9%) underwent surgical exploration, and 11 had surgically relevant THVMI (4.1%). Ninety-four patients were intubated on the field; for them, data regarding abdominal pain/tenderness were not available. In the whole cohort, the Niguarda Scoring model achieved an AUC of 0.87 (95%CI: 0.69–1.00). Other THVMI scores AUCs were: Faget 0.87 (95%CI: 0.7-1.00), BIPS 0.89 (95%CI: 0.77-1.00), BBMI 0.85 (95%CI: 0.71–0.99), RAPTOR 0.72 (95%CI: 0.50–0.95). In the subset of patients for whom clinical data were not available, the AUC was 0.91 (95%CI: 0.81-1.00), 0.87 (95%CI: 0.74–0.99), and 0.75 (95%CI: 0.58–0.91) for the Niguarda, Faget, and RAPTOR scores, respectively. DeLong tests failed to highlight any significant difference with the other scores.

Conclusions

The Niguarda Score demonstrated excellent discrimination and calibration. Its performance was at least comparable to other established THVMI scoring systems. Its simplicity, reproducibility, and robust accuracy support its integration into clinical workflows for early risk stratification in blunt abdominal trauma. Prospective multicenter studies are warranted to confirm these findings and assess the impact on management.