Profile and management of patients from low-middle socioeconomic status with thoracic trauma.

Background: Pain and shortness of breath (SOB) after thoracic trauma predispose patients to complications and prolonged hospital length of stay (LOS). Patient management after thoracic trauma is seldom reported.

Objectives: To describe patient profiles, symptoms, management, adverse events, complications, discharge destinations and follow-up referral services.

Method: Prospective observational design using clinical record review at two university-affiliated hospitals over 18 months. Adults with thoracic trauma diagnosis were consecutively screened for inclusion. Study objectives guided information retrieved from records. Statistical analyses were done with significance at < 0.05.

Results: Most were male ( = 170/179; 95%). Penetrating trauma following assault was common ( = 146/179; 82%). Conservative management included analgesia ( = 176/178; 98%) and intercostal drain insertion ( = 165/179; 92%). Physiotherapists treated patients daily. Management involved functional activities (cycling [ = 71/149; 48%], early mobilisation [ = 120/174; 69%]), lung volume enhancement (deep breathing exercises [ = 97/174; 56%], positive expiratory pressure [ = 98/174; 56%]), secretion removal (active coughing [ = 60/174; 34%]). Shoulder ( = 43/174; 25%) and trunk ( = 6/153; 4%) ROM were seldom done. Blunt trauma caused higher pain during deep breathing (median 7/10; IQR: 3.5-8.0) versus penetrating trauma (median 4/10; IQR: 2.0-7.5; = 0.04). Most reported 'slight' to 'very slight' SOB. Time out-of-bed and distance walked increased daily with smokers mobilising away from bed frequently ( = 73/95; 77%). Few adverse events and complications occurred. Mean LOS was 5.5 ± 4.3 days. Most were discharged home ( = 177/179; 99%); two were referred for follow-up physiotherapy.

Conclusion: Management is guided by individual patient needs. Treatment comprises early mobilisation, lung volume enhancement, and secretion removal with less attention on ROM exercises and post-discharge services.

Clinical Implications: Shoulder and trunk ROM should be prioritised. Service delivery approaches need review considering the evidence.