Profile and management of patients from low-middle socioeconomic status with thoracic trauma.

BACKGROUND

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.

OBJECTIVES

To describe patient profiles, symptoms, management, adverse events, complications, discharge destinations and follow-up referral services.

METHOD

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.

RESULTS

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.

CONCLUSION

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.

CLINICAL IMPLICATIONS

Shoulder and trunk ROM should be prioritised. Service delivery approaches need review considering the evidence.