What is the optimal care pathway for patients with blunt chest wall trauma presenting to the ED?

Abstract

Three-part question[In adults with blunt chest wall trauma presenting to the ED], what is the [optimal care pathway] for [days alive and out of hospital, quality of life at 6 months and patient reported experience]? Clinical scenarioA 54-year-old man attends your department having fallen off a two-step ladder on to a wooden chair. On their arrival the patient is complaining of right-sided chest pain. His vital signs are normal and there is no evidence of respiratory distress. On examination the patient is tender over rib 4, 5 and 6 on the right side but no further abnormality is identified but the patient has high levels of pain in the department despite receiving analgesics. There are many components to the patient's care that are required (e.g., analgesia, imaging, risk stratification, physiotherapy, ED discharge location) and these can be delivered using a formal care pathway. The optimal care pathway for managing patients with blunt chest trauma is yet to be determined. Search strategySearch strategies were developed by combining free-text and index term searching. A structured literature search was conducted (revised search: 25th May 2022) through the database Medline (Ovid) broadly following a previously published evidence review. 1 The following search strategy was used for all electronic databases with * denoting specific MeSH terms used in the review search strategy:

Clinical prediction models for the management of blunt chest trauma in the Emergency Department: a systematic review

“…award setting, as up to 10% of patients will decompensate after 48-72 hours. [1][2][3] Intensive Care Unit (ICU) referral from the ED must be carefully considered and as a result, much has been published over the last 20 years investigating the predictors of poor outcome in this patient cohort. 4,5 These predictors include patient age, severity of injury, number and location of rib fractures, pre-injury anticoagulants, chronic lung disease and others.…”