Physician-Led Thoracic Trauma Management in a Specialist Emergency Care Centre

Introduction: Falls cause 75% of trauma in patients above 65 years of age, and thoracic trauma is the second commonest injury; rib fractures are the most common thoracic injury. These patients have up to 12% mortality, with 31% developing pneumonias. There is wide variation in care. Northumbria Healthcare has a team of respiratory consultants, physiotherapists, specialist nurses and anesthetists for thoracic-trauma management on a respiratory support unit.

Methods: With Caldicott approval, basic demographics and clinical outcomes of patients admitted with thoracic trauma between 20 August-21 April were analyzed. A descriptive statistical methodology was applied.

Results: A total of 119 patients were identified with a mean age of 71.1 years (range 23-97). Of the 119 patients, 53 were male, 66 females. The main mechanism of injury was falls from standing (65) and falls down stairs/bed or in the bath (18). Length of stay was 7.3 days (range 1-54). In total, 85 patients had more than one co-morbidity, 26 had a full trauma assessment and 75 had pan CTs. The mean number of rib fractures was 3.6 and 31 (26%) patients had a pneumothorax and/or haemothorax. A total of 18 chest drains were inserted (all small bore) and one needle aspiration was performed. No cardiothoracic input was required. Isolated chest trauma was present only in 45 patients. All patients had a pain team review, 22 erector spinae catheters were inserted with 2 paravertebral blocks. Overall, 82 patients did not require oxygen, 1 required CPAP and 1 HFNC. 7 needed intensive care transfer. Furthermore, 20 (17%) developed pneumonias and 16 (14%) deaths occurred within 30 days-all were in those with falls from standing. There was no correlation between number of fractured ribs, length of stay and mortality.

Conclusions: High level care for thoracic trauma can be performed by a physician led team. Overall, 42% pneumothoraces/haemothoraces were observed. Further large scale randomised trials are warranted for definitive outcomes.