The use of a decision-making tool to optimise physiotherapy practice for patients following chest trauma: Impact on patient and hospital outcomes

Abstract

Introduction

Physiotherapy management for patients with blunt chest wall trauma is key for improving respiratory and functional status. Utilising a physiotherapy-specific treatment decision-making pathway, based on risk assessment, may optimise resource use and improve patient-based outcomes.

Methods

Patients with blunt chest trauma admitted to the trauma ward of a level 1 trauma centre were triaged utilising the STUMBL score (a risk assessment tool specific for blunt chest trauma) and managed as per a treatment algorithm whereby high-risk patients received intensive physiotherapy. Demographic data were described and analysis of patient and hospital outcomes was undertaken comparing the low and high risk groups. A regression analysis was completed to review the association between the groups and length of stay (LOS), taking into account confounding factors.

Results

Over the 10-month period beginning in November 2020, there were 539 patients admitted following chest trauma of which 333 (62%) were stratified as high-risk. These high-risk patients were older, more likely to be frail and live alone and more likely to have an ICU admission. There was a similar rate of discharge home across both groups (p = 0.55) and there was no difference between groups in the hospital LOS of patients after accounting for the confounders.

Conclusion

Utilising a physiotherapy decision-making algorithm based on risk assessment can facilitate the targeting of high-risk patients to receive intensive physiotherapy. This high-risk group showed similar rates of discharge home despite being a more frail, elderly population with a greater ICU admission rate. The algorithm was easy to use and may be an avenue for improved resource utilisation.