Objective

A retrospective review of patients presenting to a single institution with chest trauma to determine the injury characteristics of those undergoing chest wall fixation versus conservative management and investigate any differences in length of stay, days ventilated and post-discharge patient reported quality of life outcome measures.

Methods

Two patient groups were identified from prospectively collected databases who had chest wall fixation or non-operative management for chest wall trauma. The groups were matched on age and injury severity score, which was determined from CT scan reports. Electronic records were used to determine length of stay and days ventilated. A postal survey of a modified Rand 36 questionnaire was distributed to determine patient reported outcome.

Results

20 patients who had fixation and 60 conservatively managed patients were identified. Mean age 49 and 51 respectively. Median chest AIS identical (4) but fixation group had a higher overall ISS (median 20 vs 17). Majority of patients fixed had a flail chest (68% vs 46%) and a greater number required ventilation (21% vs 17%). Length of stay was similar (13.9 vs 13.6 days). Full results from the patient reported outcome survey are awaited but the trend is towards better outcome for fixation.

Conclusion

Chest wall fixation in trauma is recommended by NICE as a strategy in the management of complex chest wall injuries. Our study shows that the majority of patients undergoing fixation in our institution have a flail chest and a higher injury severity score. Despite an increased injury burden, the fixation group had a similar length of stay to those conservatively treated but with a lower ISS. Full patient reported outcome data is awaited but the trend is towards better outcome for fixation.