title: Blunt chest trauma in a non-specialist centre: Right treatment, right place?
abstract: OBJECTIVE
  To compare patient characteristics, management and outcomes for patients admitted with isolated blunt chest trauma, managed by medical or surgical teams.
  
  
  METHODS
  We reviewed adult patients admitted with blunt chest trauma between 1 September 2006 and 31 August 2011 to a secondary hospital in New Zealand. Inclusion criteria were: blunt chest trauma, with at least one radiologically demonstrated rib fracture. The primary outcome was in-hospital mortality, and secondary outcomes were development of pneumonia, and use of analgesia.
  
  
  RESULTS
  Seventy-two patients were included. Thirty-three patients were managed by medical teams and 39 by surgical teams. In-hospital mortality was greater amongst medical patients 5/33 (15%) versus surgical 0/39 (0%); P = 0.012. Pneumonia occurred in 15/33 (45%); medical patients versus surgical 2/39 (5%), P <0.001. Use of epidural, regional or patient-controlled analgesia was greater in the group managed by surgical teams (12/39 [30.7%] vs 1/33 [3%] P = 0.002). Medically managed patients were older (median 73 vs 63 years; P = 0.02), had a higher Charlson Comorbidity Index (median 5 vs 3; P = 0.013). The mechanism of injury for medically managed patients was more likely to be low trauma fall compared to surgically managed patients (28/33 [85%] vs 9/39 [27%]; P <0.0001).
  
  
  CONCLUSIONS
  Amongst patients with isolated blunt chest trauma, those managed by medical teams were older, had more comorbidities and were more likely to have become injured with a low trauma fall than those managed by surgical teams. They had less access to analgesic options, developed pneumonia more often and had higher mortality.
authors.affiliation: Intensive Care Unit, North Shore Hospital, Auckland, New Zealand.
authors.forename: Lesley
authors.initials: L
authors.lastname: Maher
authors.affiliation: Department of Medicine, Hutt Hospital, Lower Hutt, New Zealand.
authors.forename: Sisira
authors.initials: S
authors.lastname: Jayathissa
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D011014:Pneumonia / Q000209:etiology; D012189:Retrospective Studies; D012253:Rib Fractures / Q000209:etiology; D012307:Risk Factors; D013898:Thoracic Injuries / Q000150:complications / Q000401:mortality / Q000628:therapy; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000401:mortality / Q000628:therapy; D055815:Young Adult
chemical_list: D000700:Analgesics
keywords: frail elderly; rib fractures; thoracic injuries