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 p < 0.05. Results: Most were male (n = 170/179; 95%). Penetrating trauma following assault was common (n = 146/179; 82%). Conservative management included analgesia (n = 176/178; 98%) and intercostal drain insertion (n = 165/179; 92%). Physiotherapists treated patients daily. Management involved functional activities (cycling [n = 71/149; 48%], early mobilisation [n = 120/174; 69%]), lung volume enhancement (deep breathing exercises [n = 97/174; 56%], positive expiratory pressure [n = 98/174; 56%]), secretion removal (active coughing [n = 60/174; 34%]). Shoulder (n = 43/174; 25%) and trunk (n = 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; p = 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 (n = 73/95; 77%). Few adverse events and complications occurred. Mean LOS was 5.5 ± 4.3 days. Most were discharged home (n = 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.