Acute minor thoracic injuries: evaluation of practice and follow-up in the emergency department.

OBJECTIVE

To review the management and follow-up of patients with minor thoracic injuries (MTI) treated by emergency or primary care physicians.

DESIGN

A multicentre, retrospective study.

SETTING

Three university-affiliated emergency departments of the metropolitan region of Quebec city, Que.

PARTICIPANTS

Patients older than 16 years of age with suspected or proven rib fractures following traumatic events.

MAIN OUTCOME MEASURES

Differences in admission and discharge proportions and disposition management following MTI.

RESULTS

Four hundred and forty-seven charts were analyzed. Only 23 patients (5.2%) were admitted during the study period. Admission and discharge proportions were significantly different among the 3 surveyed hospitals, ranging from 1.3% to 15.2% (P < or = .001). There were no recommendations of follow-up noted in most (53.5%) of the charts and there were no differences after hospital stratification. Planned follow-up visits were scheduled for 5.7% of discharged patients. Being older than 65 years of age or having multiple rib fractures had no influence on management and follow-up recommendations. Eighty-two patients (18.6%) had unplanned follow-up visits in the emergency department, with inadequate pain relief as the principal reason for consultation (56.1%). There was no significant difference after stratification for age and type of analgesia. Other clinically significant delayed complications were recorded in 8.3% of all MTI patients.

CONCLUSION

The proportion of patients admitted for rib fractures was lower than the expected 25%, based on previous publications, and varied across surveyed hospitals. A very low proportion of patients was offered planned follow-up visits or even any follow-up recommendations in view of possible delayed complications and disabilities. Further studies are needed to identify predictors of delayed MTI complications and enhance appropriate use of follow-up resources.