Clinical presentation, acute care management and discharge information of patients with thoracic trauma: a prospective multicenter observational study.

To report levels of pain and shortness of breath and its influence on hospital length of stay (LOS), acute care management strategies used, and discharge information for patients with thoracic trauma in South Africa (SA) and Sweden.

A prospective observational multicenter study by means of clinical record review at six participating public sector university-affiliated hospitals. One thousand nine hundred and eighteen adults with thoracic trauma were screened. Consecutive sampling was used. Study objectives guided information retrieved by clinician physiotherapists from patients’ clinical records. Participants were treated according to standard trauma and physiotherapy practice at all sites. Data was prospectively collected over 12 months in Sweden and 18 months in SA. Statistical analysis was done with significance at p0.05.

Three-hundred-sixty-four participants were recruited with most being male (n=170 (95%) SA; n=125 (68%) Sweden). Type and mechanism of injury differed (SA penetrating (82%) versus Sweden blunt (95%); SA assaults (90%) versus Sweden falls (44%)). Unilateral haemopneumothorax was common (SA 68%, Sweden 35%) and managed with intercostal drainage. Rib cage injuries were common in the Swedish cohort with rib fixation surgery for 17%. Few required mechanical ventilation. Physiotherapy treatment frequency was mostly daily. Swedish participants reported higher pain levels during deep breathing (day 1: p=0.053; day 2: p0.001; day 3: p0.001). Shortness of breath during activity was higher for the Swedish cohort (day 1: p=0.023; day 2: p=0.001; day 3: p0.001). LOS was shorter for the SA cohort (5.4 (±4.3) versus 6.6 (±5.1) days; p=0.024). Atelectasis developed in 2% SA cohort vs 9% Swedish cohort. Pulmonary complications (p=0.013) and moderate-to-severe pain on day 3 (p=0.005) influenced LOS. Discharge destination was mostly home (99% SA, 56% Sweden).

This study provides a mirror of actual clinical practice at the participating sites. It confirms the contextual differences in clinical presentation, acute care management and discharge destinations of patients with thoracic trauma in SA and Sweden.

Moderate-to-severe pain reported on day three of hospital stay suggests that care, in the form of analgesia review and physiotherapy management, be prioritised for those with thoracic trauma to prevent onset of pulmonary complications and resultant prolonged hospital LOS.