PONE-D-22-02469Road traffic accident-related thoracic trauma: epidemiology, injury pattern, outcome, and impact on mortality – a multicenter observational study from 1997 to 2016PLOS ONE

Dear Dr. BENHAMED,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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Please submit your revised manuscript by Apr 07 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

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Belinda J Gabbe, PhD

Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Thank you for the opportunity to read and comment on this interesting manuscript by Benhamed, et al., entitled, “Road traffic accident-related thoracic trauma: epidemiology, injury pattern, outcome, and impact on mortality – a multicenter observational study from 1997 to 2016.” This is a retrospective, cohort study using data from the Rhone RTA registry, aimed at describing patient characteristics, injury patterns, and outcome among patients with one or more thoracic injuries sustained in an RTA during a 20-year interval. They find that RTA-related thoracic injuries were rare (3.6%) and injury patterns and mechanisms varied by age group.

1. The manuscript is organized and the prose is clearly written. Overall, the authors have done a fine job of describing the cohort and identifying trends in the data, particularly with regard to age. However, I think much more can be accomplished with the data they already have in hand.

The authors need to take the element of time into consideration given the 20-year span of the dataset. Trauma care has changed substantially over the 20 years of the study. At the very least, year of injury could be included in the regression models as random parameters. One could go so far as comparing standardized survival ratios over time. However, this is completely at the authors’ discretion. Nonetheless, the matter of time needs to be acknowledged as a variable in Table 1 and included in the results, as appropriate.

2. The authors give a good description of the limitations of the Rhone RTA registry. Is there information regarding chronic comorbid diseases in the Rhone RTA registry? If such data are available, inclusion in the analyses would be instructive. If not, fine.

3. How was missing data handled? Was there any missing data? Some mention of missingness would be useful to readers.

4. The description of the logistic model fitting process is appreciated. Could the authors please include the area under the receiver operating characteristic curve to convey the discrimination of the model?

5. The figures are clearly presented and are very instructive. Well done.

Minor point:

1. The third sentence of the introduction, line 80, “Furthermore…” needs to be clarified. The phrases “third most common cause of death…” and “up to 25% of trauma-related deaths” need to be reconciled somehow.

Thank you for your kind consideration of my comments and questions. I look forward to your replies and revisions.

Reviewer #2: Thank you for the opportunity to read this well written, descriptive analysis of road crash related thoracic trauma from the Rhone region.

However, the authors have indicated 2 significant flaws in the paper.

The first is the inclusion of subjects prior to the adoption of whole body CT scanning. The diagnoses of rib fractures and pulmonary injuries - for example - can be considered under-reported.

Secondly , road crash fatalities rates had reduced by 50% in developed systems during the reporting period (1997-2018), yet the cohort is presented as a uniform population (see, for example, https://www.statista.com/statistics/437904/number-of-road-deaths-in-france/ accessed 21Feb2022).

Both these factors make interpreting the data difficult.

Would the authors consider:

1. Including more contemporaneous data (e.g. 1997-2021)?

2. Analysing the incidence of diagnoses as well as the changes in mortality and outcomes over time?

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Reviewer #1: Yes: Alan Cook, MD, MS, FACS

Reviewer #2: Yes: Mark C Fitzgerald

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PONE-D-22-02469R1Road traffic accident-related thoracic trauma: epidemiology, injury pattern, outcome, and impact on mortality – a multicenter observational studyPLOS ONE

Dear Dr. BENHAMED,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Your manuscript has been positively appraised by our reviewers. Notwithstanding, there are some additional revisions needed from you, as you can see below in the section "Comments to the author". Therefore, and before considering accepting this paper for publication in PLOS ONE, I must ask you to respond to all the remaining comments and suggestions in a suitable and detailed way. Once receiverd these revisions from you, I will proceed to check them personally, in order to make a prompt editorial decision on your study

Please submit your revised manuscript by Jun 03 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Sergio A. Useche, Ph.D.

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: (No Response)

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: (No Response)

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Thank you for your kind consideration of my questions and comments. Well done. Congratulations on a fine article.

Reviewer #2: Thank you for you revision which reads well.

One final comment - you conclude 'Significant RTA-related thoracic injuries were rare' - but I think you mean 'Major cardiac, vascular, tracheobronchial and oesophageal injuries were rare...'?

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: Yes: Mark Fitzgerald

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Road traffic accident-related thoracic trauma: epidemiology, injury pattern, outcome, and impact on mortality – a multicenter observational study

PONE-D-22-02469R2

Dear Dr. BENHAMED,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Sergio A. Useche, Ph.D.

Academic Editor

PLOS ONE

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