Chest trauma: an experience of a Respiratory Support Unit with level 2 care in the North East of England.
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Authors
Aujayeb, Avinash
Basterfield, T
Bates-Powell, Jonny
Jackson, Karl
Issue Date
2021
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Abstract
"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 commonest thoracic injury. There is wide variation in care. Older trauma patients are less likely to have trauma assessments. Rib fractures carry up to 12% mortality with up to 31% developing pneumonia.1 The number of fractures correlates with morbidity. Northumbria Healthcare has a team of respiratory consultants, physiotherapists, specialist nurses and anaesthetists for rib fracture management on a respiratory support unit.
Methods: With Caldicott approval, basic demographics and clinical outcomes of patients admitted with thoracic trauma between Aug 20-Apr 21 were analysed. Descriptive statistical methodology was applied.
Results: 119 patients were identified. Mean age was 71.1 years (range 23–97). 53 were male, 66 female. Mechanism of injury were falls from standing (65), falls down stairs/bed or in the bath (18), ladders (4), cycling (12), assault (3), road accidents (8) and 9 others (for example off horses). LOS was 7.3 days (range 1–54). 85 patients had more than 1 co-morbidity. 26 had a full trauma assessment and 75 had pan CTs. Mean number of rib fractures was 3.6. 31 (26%) had a pneumothorax and/or haemothorax. 18 chest drains were inserted (all small bore) and 1 needle aspiration done. No cardiothoracic input was required. Isolated chest trauma was present only in 45 patients. All had pain team review, 22 erector spinae catheters were inserted with 2 paravertebral blocks. 82 patients did not require oxygen, 1 required CPAP and 1 HFNC. 7 needed intensive care transfer. 20 (17%) developed pneumonias.16 (14%) deaths occurred within 30 days (1 heart failure and cancer progression, 2 Covid and 14 pneumonias)- 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 the respiratory team with analgesia managed by the pain team. 42% of pneumothoraces/haemothoraces were observed. Falls from standing are associated with significant mortality and morbidity. The service is now complemented by a frailty assessment service."
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Citation
Jackson, K., Basterfield, T., Bates-Powell, J. et al. (2021) S76?Chest trauma: an experience of a Respiratory Support Unit with level 2 care in the North East of England. Thorax; 76 : A49.
Publisher
Thorax
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PubMed ID
ISSN
1468-3296