Clinical presentation, acute care management and discharge information of patients with thoracic trauma in South Africa and Sweden: a prospective multicenter observational study.

Abstract

<title>Abstract</title> Purpose: Thoracic trauma causes pain and hospitalisation. Middle- and high-income countries have different trauma contexts and populations. To report patients’ clinical presentation (pain and shortness of breath) and its influence on hospital length of stay (LOS), acute care management, and discharge destinations in South Africa (SA) and Sweden. Methods: Prospective observational multicenter study by means of clinical record review. One thousand nine hundred and eighteen adults with thoracic trauma were screened. Study objectives guided information retrieved from clinical records. Statistical analysis was done with significance at p-value &lt; 0.05. Results: Three-hundred-sixty-four participants were recruited with most being male (n = 170 (95%) SA; n = 125 (68%) Sweden). Type and mechanism of injury differed (SA penetrating (82%) versus Sweden blunt (95%); SA assaults (90%) versus Sweden falls (44%)). Unilateral haemopneumothorax was common (SA 68%, Sweden 35%) and managed with intercostal drainage. Rib cage injuries were common in the Swedish cohort with rib fixation surgery for 17%. Physiotherapy treatment frequency was mostly daily. Swedish participants reported higher pain levels during deep breathing (day 1: p = 0.053; day 2: p &lt; 0.001; day 3: p &lt; 0.001). Shortness of breath during activity was higher for the Swedish cohort (day 1: p = 0.023; day 2: p = 0.001; day 3: p &lt; 0.001). LOS was shorter for SA cohort (5.4 (± 4.3) versus 6.6 (± 5.1) days; p = 0.024). Pulmonary complications (p = 0.013) and moderate-to-severe pain on day 3 (p = 0.005) influenced LOS. Discharge destination was mostly home (99% SA, 56% Sweden). Conclusion: Moderate-to-severe pain on day three suggests priority care for those with thoracic trauma to prevent pulmonary complications and prolonged hospitalisation.