van Aswegen Heleen, Roos Ronel, Haarhoff Elizma, de Kock Josslyn, Ebrahim Humairaa, Tootla Sameer, Vally Muhammad, Olsén Monika Fagevik
Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Department of Therapeutic Services, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.
S Afr J Physiother. 2025 Jun 27;81(1):2146. doi: 10.4102/sajp.v81i1.2146. eCollection 2025.
Pain and shortness of breath (SOB) after thoracic trauma predispose patients to complications and prolonged hospital length of stay (LOS). Patient management after thoracic trauma is seldom reported.
To describe patient profiles, symptoms, management, adverse events, complications, discharge destinations and follow-up referral services.
Prospective observational design using clinical record review at two university-affiliated hospitals over 18 months. Adults with thoracic trauma diagnosis were consecutively screened for inclusion. Study objectives guided information retrieved from records. Statistical analyses were done with significance at < 0.05.
Most were male ( = 170/179; 95%). Penetrating trauma following assault was common ( = 146/179; 82%). Conservative management included analgesia ( = 176/178; 98%) and intercostal drain insertion ( = 165/179; 92%). Physiotherapists treated patients daily. Management involved functional activities (cycling [ = 71/149; 48%], early mobilisation [ = 120/174; 69%]), lung volume enhancement (deep breathing exercises [ = 97/174; 56%], positive expiratory pressure [ = 98/174; 56%]), secretion removal (active coughing [ = 60/174; 34%]). Shoulder ( = 43/174; 25%) and trunk ( = 6/153; 4%) ROM were seldom done. Blunt trauma caused higher pain during deep breathing (median 7/10; IQR: 3.5-8.0) versus penetrating trauma (median 4/10; IQR: 2.0-7.5; = 0.04). Most reported 'slight' to 'very slight' SOB. Time out-of-bed and distance walked increased daily with smokers mobilising away from bed frequently ( = 73/95; 77%). Few adverse events and complications occurred. Mean LOS was 5.5 ± 4.3 days. Most were discharged home ( = 177/179; 99%); two were referred for follow-up physiotherapy.
Management is guided by individual patient needs. Treatment comprises early mobilisation, lung volume enhancement, and secretion removal with less attention on ROM exercises and post-discharge services.
Shoulder and trunk ROM should be prioritised. Service delivery approaches need review considering the evidence.
胸部创伤后的疼痛和呼吸急促（SOB）使患者易发生并发症并延长住院时间（LOS）。关于胸部创伤后患者管理的报道很少。
描述患者概况、症状、管理、不良事件、并发症、出院去向及随访转诊服务。
采用前瞻性观察设计，对两所大学附属医院18个月内的临床记录进行回顾。对诊断为胸部创伤的成年人进行连续筛查以纳入研究。研究目标指导从记录中检索信息。进行统计学分析，显著性水平设定为<0.05。
大多数为男性（n = 170/179；95%）。袭击后导致的穿透性创伤很常见（n = 146/179；82%）。保守治疗包括镇痛（n = 176/178；98%）和肋间引流管插入（n = 165/179；92%）。物理治疗师每天为患者进行治疗。治疗包括功能活动（骑自行车[n = 71/149；48%]、早期活动[n = 120/174；69%]）、肺容积增加（深呼吸练习[n = 97/174；56%]、呼气末正压[n = 98/174；56%]）、分泌物清除（主动咳嗽[n = 60/174；34%]）。很少进行肩部（n = 43/174；25%）和躯干（n = 6/153；4%）的关节活动度（ROM）训练。钝性创伤在深呼吸时引起的疼痛更高（中位数7/10；四分位间距：3.5 - 8.0），而穿透性创伤引起的疼痛较低（中位数4/10；四分位间距：2.0 - 7.5；P = 0.04）。大多数患者报告有“轻微”至“非常轻微”的呼吸急促。吸烟者频繁离床活动，其下床时间和行走距离每天都在增加（n = 73/95；77%）。发生的不良事件和并发症很少。平均住院时间为5.5±4.3天。大多数患者出院回家（n = 177/179；99%）；两名患者被转诊接受后续物理治疗。
管理以患者个体需求为导向。治疗包括早期活动、肺容积增加和分泌物清除，对关节活动度训练和出院后服务关注较少。
应优先进行肩部和躯干的关节活动度训练。考虑到现有证据，需要对服务提供方式进行审查。
