MP49: Does reduced cough capacity in minor thoracic trauma leads to more atelectasis development?

Abstract

Introduction: Minor thoracic trauma (MTI) accounts for approximately 15% of all injuries treated in the emergency department (ED). Many of which are minor and will be handle on an outpatient basis. MTI and rib fractures especially cause non-negligible pain. The pain experienced by patients can lead to reduce pulmonary function, decrease mucous clearance and decrease cough capacity leading in infectious problems and atelectasis. To our knowledge, there is no study of atelectasis development caused by reduced cough capacity in the setting of MTI. Objective: Evaluate if a variation in cough capacity leads to atelectasis development. Evaluate if there was a difference in cough capacity perception between the nurse, the physician and the patient himself. Methods: A prospective observational cohort study (2006-2012) in 4 ED recruited patients with a chief complaint of MTI, ≥ 16 years old, discharged home from the ED. Exclusion criteria: 1) a confirmed hemothorax, pneumothorax, fail chest, lung contusion or any other important thoracic or abdominal internal injury at the initial visit or unable to attend follow-up visits. Patients were assessed at 7- and 14- days. For each patient, age, sex, mechanism of injury, dyspnea, COPD/asthma and smoking status were collected. Chest x-ray was done at each visit; pulmonary complications were assessed by a blind radiologist. Cough capacity was assessed on a scale of 0 to 10 by a nurse, physician and patient himself at 0, 7- and 14- days. Pain was scored on a scale of 0 to 10. Chi -squared and odds ratio (IC: 95%. p ≤ 0.05) were assessed to determine if the cough capacity variation leads to atelectasis development. A Pearson correlation test was assessed the correlation in cough capacity among participants. Results: 1474 patients were recruited. Initial visit: 9% had atelectasis, 7 days: 7% and 4.6% at 14 days. 1105 patients were retained for analysis after exclusion of missing data. The median initial pain score was 7-8 for all patient categories. At 7 days, the odds ratio of atelectasis development were (score (0-3) 1.18 (0.42-3.34); score (4-7) 1.20 (0.48-3.03); p<=0.05). The Pearson correlation of cough capacity assessment, in patients without atelectasis were (0.53 nurse vs. patient; 0.37 physician vs. patient; 0.51 nurse vs. physician p<=0.05). As for the cough capacity perception correlation in patients with atelectasis were (0.62 nurse vs. patient; 0.40 physician vs. patient; 0.51 nurse vs. physician; p<=0.05). Conclusion: There is no statistically significant difference in atelectasis development depending on cough capacity and there is poor correlation regarding the perception of cough capacity except for the nurse. It would be interesting to develop a patient reported outcome measure questionnaire which targets minor thoracic trauma as it is a common emergency department complaint and it could help us improve medical management and patient quality of life