A survey of current practice in UK emergency department management of patients with blunt chest wall trauma not requiring admission to hospital

Battle, Ceri; O’Neill, Claire; Newey, Luke; Barnett, Jane; O’Neill, Martin; Hutchings, Hayley

doi:10.1016/j.injury.2021.06.013

Cited by 8 publications

(7 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although it is now well recognised that patients with blunt chest wall trauma are at risk of developing complications, to date no universally accepted guidelines exist to assist in the recognition of these high-risk populations 1 2. Many EDs globally have adopted clinical protocols that routinely advise admission to a critical care setting where possible for elderly patients with increasing numbers of rib fractures 3 4.…”

Section: Introductionmentioning

confidence: 99%

“…Studies have also considered whether such patients should be considered for immediate transfer to a specialist trauma unit for the appropriate level of care to be provided 5–7. In the patient with the more minor, non-immediately life-threatening injury, management is often less protocol-driven, and many different risk stratification tools and care pathways exist 1 8. As a result, clinicians still report difficulty in prognostication of patients with blunt chest wall trauma, presenting to the ED 1…”

Section: Introductionmentioning

confidence: 99%

“…In the patient with the more minor, non-immediately life-threatening injury, management is often less protocol-driven, and many different risk stratification tools and care pathways exist 1 8. As a result, clinicians still report difficulty in prognostication of patients with blunt chest wall trauma, presenting to the ED 1…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Risk factors that predict mortality in patients with blunt chest wall trauma: an updated systematic review and meta-analysis

et al. 2022

Self Cite

View full text Add to dashboard Cite

BackgroundOver the last 10 years, research has highlighted emerging potential risk factors for poor outcomes following blunt chest wall trauma. The aim was to update a previous systematic review and meta-analysis of the risk factors for mortality in blunt chest wall trauma patients.MethodsA systematic review of English and non-English articles using MEDLINE, Embase and Cochrane Library from January 2010 to March 2022 was completed. Broad search terms and inclusion criteria were used. All observational studies were included if they investigated estimates of association between a risk factor and mortality for blunt chest wall trauma patients. Where sufficient data were available, ORs with 95% CIs were calculated using a Mantel-Haenszel method. Heterogeneity was assessed using the I2statistic.Results73 studies were identified which were of variable quality (including 29 from original review). Identified risk factors for mortality following blunt chest wall trauma were: age 65 years or more (OR: 2.11; 95% CI 1.85 to 2.41), three or more rib fractures (OR: 1.96; 95% CI 1.69 to 2.26) and presence of pre-existing disease (OR: 2.86; 95% CI 1.34 to 6.09). Other new risk factors identified were: increasing Injury Severity Score, need for mechanical ventilation, extremes of body mass index and smoking status. Meta-analysis was not possible for these variables due to insufficient studies and high levels of heterogeneity.ConclusionsThe results of this updated review suggest that despite a change in demographics of trauma patients and subsequent emerging evidence over the last 10 years, the main risk factors for mortality in patients sustaining blunt chest wall trauma remained largely unchanged. A number of new risk factors however have been reported that need consideration when updating current risk prediction models used in the ED.PROSPERO registration numberCRD42021242063. Date registered: 29 March 2021.https://www.crd.york.ac.uk/PROSPERO/%23recordDetails.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Risk factors that predict mortality in patients with blunt chest wall trauma: an updated systematic review and meta-analysis

et al. 2022

Self Cite

View full text Add to dashboard Cite

show abstract

“…It was reported by Baker et al in the RIOS study that despite a trend towards improving pain and physical functional at 6 months postinjury, outcomes did not return to participants perceived baseline level of function 3. In most hospitals in the UK, however, patients are simply discharged home with no follow-up care 4. Clinicians are traditionally taught that the pain and disability of rib fractures resolves in 6–8 weeks 1.…”

Section: Introductionmentioning

confidence: 99%

“… 3 In most hospitals in the UK, however, patients are simply discharged home with no follow-up care. 4 Clinicians are traditionally taught that the pain and disability of rib fractures resolves in 6–8 weeks. 1 What remains unknown in blunt chest trauma literature, is the best management for addressing the longer-term complications, specifically chronic pain and disability.…”

Section: Introductionmentioning

confidence: 99%

Early exercise in blunt chest wall trauma: protocol for a mixed-methods, multicentre, parallel randomised controlled trial (ELECT2 trial)

et al. 2022

Self Cite

View full text Add to dashboard Cite

IntroductionChronic pain and disability are now well-recognised long-term complications of blunt chest wall trauma. Limited research exists regarding therapeutic interventions that can be used to address these complications. A recent feasibility study was completed testing the methods of a definitive trial. This protocol describes the proposed definitive trial, the aim of which is to investigate the impact of an early exercise programme on chronic pain and disability in patients with blunt chest wall trauma.Methods/analysisThis mixed-methods, multicentre, parallel randomised controlled trial will run in four hospitals in Wales and one in England over 12-month recruitment period. Patients will be randomised to either the control group (routine physiotherapy input) or the intervention group (routine physiotherapy input plus a simple exercise programme completed individually by the patient). Baseline measurements including completion of two surveys (Brief Pain Inventory and EuroQol 5-dimensions, 5-Levels) will be obtained on initial assessment. These measures and a client services receipt inventory will be repeated at 3-month postinjury. Analysis of outcomes will focus on rate and severity of chronic pain and disability, cost-effectiveness and acceptability of the programme by patients and clinicians. Qualitative feedback regarding acceptability will be obtained through patient and clinician focus groups.Ethics/disseminationLondon Riverside Research Ethics Committee (Reference number: 21/LO/0782) and the Health Research Authority granted approval for the trial in December 2021. Patient recruitment will commence in February 2022. Planned dissemination is through publication in a peer-reviewed Emergency Medicine Journal, presentation at appropriate conferences and to stakeholders at professional meetings.Trial registration numberISRCTN65829737; Pre-results.

show abstract

Scoping review of the literature to ascertain how the STUMBL Score clinical prediction model is used to manage patients with blunt chest wall trauma in emergency care

Battle

Cole

Whelan

et al. 2023

Injury

View full text Add to dashboard Cite

A survey of current practice in UK emergency department management of patients with blunt chest wall trauma not requiring admission to hospital

Cited by 8 publications

References 27 publications

Risk factors that predict mortality in patients with blunt chest wall trauma: an updated systematic review and meta-analysis

Risk factors that predict mortality in patients with blunt chest wall trauma: an updated systematic review and meta-analysis

Early exercise in blunt chest wall trauma: protocol for a mixed-methods, multicentre, parallel randomised controlled trial (ELECT2 trial)

Scoping review of the literature to ascertain how the STUMBL Score clinical prediction model is used to manage patients with blunt chest wall trauma in emergency care

Contact Info

Product

Resources

About