Bundle of care for blunt chest trauma patients improves analgesia but increases rates of intensive care unit admission: A retrospective case-control study

How does the implementation of a patient pathway-based intervention in the acute care of blunt thoracic injury impact on patient outcomes? A systematic review of the literature

“…There was distinct variability in both the overall focus and individual components of the patient pathway-based interventions included in this study. The main focus areas of blunt thoracic injury care were identified as: analgesic management [16] , [17] , [18] , [19] , [20] , [21] ; respiratory care [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] ; surgical decision making (including chest drain management) [18 , [24] , [25] , [26] , [27] , [28] ; and reducing the risk of in-patient complications [ [16] , [17] , [18] , [19] , [20] , [21] , 29 , 30 ]. Outcome measures analysed in these studies included: Hospital Length of Stay; Intensive Care Unit Length of Stay; Rates of Pneumonia; Ventilatory support/respiratory function; Mortality; Thoracic Surgical Interventions; Analgesia; and Financial savings.…”

“…of thoracic fractures Injury Severity Score Carrie et al. (2017) [18] Protocol group vs. Control group (Mean in years) 58 (±16) vs. 58 (±15); p = 0.85 Protocol group vs. Control group 78% ( n = 54) vs. 78% (54); p = 1.0 Protocol group vs. Control group Bilateral Rib Fractures: 32% ( n = 22) vs. 23% ( n = 16); p = 0.25 Flail Segment: 22% ( n = 15) vs. 17% ( n = 12); p = 0.52 Pulmonary Contusion: 59% ( n = 41) vs. 52% ( n = 36); p = 0.39 Pneumothorax: 48% ( n = 33) vs. 62% ( n = 43); p = 0.09 Haemothorax: 39% ( n = 27) vs. 57% ( n = 39); p = 0.05 Protocol group vs. Control group (mean no. of #) 6 (±3) vs. 6 (±2); p = 0.56 Protocol group vs. Control group 17 (±7) vs. 17 (±7); p = 0.97 Thoracic Trauma Severity Score: 8 (±3) vs. 8 (±3); p = 0.97 Curtis et al.…”

“…Phase I vs. Phase II Median score 19 (IQR 10–25) vs. 13 ( [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] ) vs. 10 ( [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] ); p = 0.002 Anderson et al. (2015) [25] Not reported Not reported Not reported Not reported Not reported Gonzalez et al.…”

Improved Outcomes after Surgical Stabilization of Rib Fractures in Patients with Polytrauma and Associated Chest Wall Fractures

“…Objective evidence of pulmonary function based on incentive spirometry volumes, oxygenation and pain control is followed and surgical fixation is offered to patients who fail any of those measures. Data continues to emerge evaluating multimodality pain control for the management of chest wall injuries, and it is unclear that pain control alone is associated with favorable outcomes as there are mixed results with some studies suggestive benefits of multimodality pain regimens, and others showing no benefit [8][9][10][11]. The expansion of surgical repair beyond the traditional indications including flail chest, perhaps enriches the protocol based outcomes, particularly with the use of muscle sparing smaller incisions.…”

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“…Objective evidence of pulmonary function based on incentive spirometry volumes, oxygenation and pain control is followed and surgical fixation is offered to patients who fail any of those measures. Data continues to emerge evaluating multimodality pain control for the management of chest wall injuries, and it is unclear that pain control alone is associated with favorable outcomes as there are mixed results with some studies suggestive benefits of multimodality pain regimens, and others showing no benefit [8][9][10][11]. The expansion of surgical repair beyond the traditional indications including flail chest, perhaps enriches the protocol based outcomes, particularly with the use of muscle sparing smaller incisions.…”