title: ChIP: An early activation protocol for isolated blunt chest injury improves outcomes, a retrospective cohort study.
abstract: BACKGROUND
  Blunt chest injuries not treated in a timely manner with sufficient analgesia, physiotherapy and respiratory support are associated with increased morbidity and mortality. The aim of the study was to determine the impact of a blunt chest injury early activation protocol (ChIP) on patient and hospital outcomes.
  
  
  METHODS
  In this pre-post cohort study, the outcomes of patients with blunt chest injury who received ChIP were compared against those who did not. Data including injury severity, patient outcomes, hospital treatments and comorbidites were extracted from medical records. The primary outcome was pneumonia. Secondary outcomes evaluated health service delivery. Logistic and multiple regressions were used to adjust for potential confounding variables.
  
  
  RESULTS
  546 patients were included, 273 in the before-ChIP cohort and 273 in the after-ChIP cohort. The incidence of pneumonia following the introduction of ChIP was reduced by 4.8% (95% CI 0.5-9.2, p=0.03). In the after-ChIP cohort, more patients received a pain team review (32% vs. 13%, p<0.001), physiotherapy (93% vs. 86%, p=0.005) and trauma team review (95% vs. 39%, p<0.001). There was no difference in length of stay (p=0.50).
  
  
  CONCLUSIONS
  ChIP improved the delivery of healthcare services and reduced the rate of pneumonia among patients with isolated chest trauma.
authors.affiliation: Sydney Nursing School, University of Sydney, Mallett St, Camperdown, NSW, Australia; Trauma Service, St George Hospital, Gray Street, Kogarah, NSW, Australia; St George Clinical School, Faculty of Medicine, University of New South Wales, High Street, Kensington, NSW, Australia; The George Institute for Global Health, Bridge Street, Sydney, NSW, Australia. Electronic address: kate.curtis@sydney.edu.au.
authors.forename: Kate
authors.initials: K
authors.lastname: Curtis
authors.affiliation: St George Clinical School, Faculty of Medicine, University of New South Wales, High Street, Kensington, NSW, Australia; Department of Emergency Medicine, St George Hospital, Gray Street, Kogarah, NSW, Australia.
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Asha
authors.affiliation: St George Clinical School, Faculty of Medicine, University of New South Wales, High Street, Kensington, NSW, Australia.
authors.forename: Annalise
authors.initials: A
authors.lastname: Unsworth
authors.affiliation: Faculty of Health Sciences, University of Sydney, East Street, Lidcombe, NSW, Australia.
authors.forename: Mary
authors.initials: M
authors.lastname: Lam
authors.affiliation: Trauma Service, St George Hospital, Gray Street, Kogarah, NSW, Australia.
authors.forename: Helen
authors.initials: H
authors.lastname: Goldsmith
authors.affiliation: Trauma Service, St George Hospital, Gray Street, Kogarah, NSW, Australia.
authors.forename: Mary
authors.initials: M
authors.lastname: Langcake
authors.affiliation: Department of Emergency Medicine, St George Hospital, Gray Street, Kogarah, NSW, Australia.
authors.forename: Donovan
authors.initials: D
authors.lastname: Dwyer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D065187:Controlled Before-After Studies; D003695:Delivery of Health Care; D016529:Emergency Nursing / Q000379:methods; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D009517:New South Wales; D010348:Patient Care Team; D011014:Pneumonia / Q000209:etiology / Q000451:nursing; D012189:Retrospective Studies; D012253:Rib Fractures / Q000451:nursing*; D013898:Thoracic Injuries / Q000209:etiology / Q000451:nursing; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000209:etiology / Q000451:nursing*
keywords: Clinical guideline; Emergency; Injury; Nursing; Pain management; Rib fracture