Management of chest trauma in a District General Hospital - Audit of current practice

Abstract

Abstract Aim Audit the management of chest trauma in a District General Hospital according to guidelines set by the regional major trauma centre (MTC). Methods Patients admitted with traumatic rib fractures over a six-month period were included. Clinical notes and imaging were reviewed. Primary outcomes were chest injury severity score (CISS), pain team review and referral to MTC. Secondary outcomes included 30-day readmission and mortality. Results 37 patients were included and only 2 had a CISS calculated on admission. Scores were retrospectively calculated with 89.2% scoring over 11 – the threshold for admission and aggressive management. 28 (75.7%) of patients met the criteria for referral to the MTC for consideration of rib fixation but only 8 were referred. 27 (73.0%) were seen by the pain team and 16 patients received a nerve block. There were 5 patients (13.5%) readmitted within 30 days of discharge with complaints of pain or dyspnoea. 3 were discharged from the emergency department, 2 required an additional inpatient stay. There were 2 deaths (5.4%) within 30 days of discharge. Cause of death was only available for 1 patient who had died of pneumonia. Conclusion Chest trauma has a high morbidity and is often managed by emergency general surgeons in centres without cardiothoracic services. Clear management guidance is vital to improving outcomes. As a result of this audit the trust’s pathway for chest trauma has been updated and new tools developed on our electronic patient record system to facilitate calculation of the CISS and completing the necessary referrals.