Original Research Profile and management of patients from low-middle socioeconomic status with thoracic trauma

Heleen van Aswegen, Ronel Roos, Elizma Haarhoff, Josslyn de Kock, Humairaa Ebrahim, Sameer Tootla, Muhammad Vally, Monika Fagevik Olsén

South African Journal of Physiotherapy | Vol 81, No 1 | a2146 | DOI: https://doi.org/10.4102/sajp.v81i1.2146 | © 2025 Heleen van Aswegen, Ronel Roos, Elizma Haarhoff, Josslyn de Kock, Humairaa Ebrahim, Sameer Tootla, Muhammad Vally, Monika Fagevik Olsén | This work is licensed under CC Attribution 4.0
Submitted: 11 November 2024 | Published: 27 June 2025

About the author(s) Heleen van Aswegen, Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Ronel Roos, Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Elizma Haarhoff, Department of Therapeutic Services, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
Josslyn de Kock, Department of Physiotherapy, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
Humairaa Ebrahim, Department of Physiotherapy, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
Sameer Tootla, Department of Physiotherapy, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
Muhammad Vally, Department of Physiotherapy, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
Monika Fagevik Olsén, Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and, Department of Physical Therapy, Sahlgrenska University Hospital and Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; and, Department of Surgery, Sahlgrenska University Hospital and Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden

Abstract

Background: Pain and shortness of breath (SOB) after thoracic trauma predispose patients to complications and prolonged hospital length of stay (LOS). Patient management after thoracic trauma is seldom reported.

Objectives: To describe patient profiles, symptoms, management, adverse events, complications, discharge destinations and follow-up referral services.

Method: Prospective observational design using clinical record review at two university-affiliated hospitals over 18 months. Adults with thoracic trauma diagnosis were consecutively screened for inclusion. Study objectives guided information retrieved from records. Statistical analyses were done with significance at p< 0.05.

Results: Most were male (n = 170/179; 95%). Penetrating trauma following assault was common (n = 146/179; 82%). Conservative management included analgesia (n = 176/178; 98%) and intercostal drain insertion (n = 165/179; 92%). Physiotherapists treated patients daily. Management involved functional activities (cycling [n = 71/149; 48%], early mobilisation [n = 120/174; 69%]), lung volume enhancement (deep breathing exercises [n = 97/174; 56%], positive expiratory pressure [n = 98/174; 56%]), secretion removal (active coughing [n = 60/174; 34%]). Shoulder (n = 43/174; 25%) and trunk (n = 6/153; 4%) ROM were seldom done. Blunt trauma caused higher pain during deep breathing (median 7/10; IQR: 3.5–8.0) versus penetrating trauma (median 4/10; IQR: 2.0–7.5; p= 0.04). Most reported ‘slight’ to ‘very slight’ SOB. Time out-of-bed and distance walked increased daily with smokers mobilising away from bed frequently (n = 73/95; 77%). Few adverse events and complications occurred. Mean LOS was 5.5 ± 4.3 days. Most were discharged home (n = 177/179; 99%); two were referred for follow-up physiotherapy.

Conclusion: Management is guided by individual patient needs. Treatment comprises early mobilisation, lung volume enhancement, and secretion removal with less attention on ROM exercises and post-discharge services.

Clinical implications: Shoulder and trunk ROM should be prioritised. Service delivery approaches need review considering the evidence.

Keywords

pain; shortness of breath; range of motion exercises; thoracic trauma; physiotherapy; penetrating trauma; blunt trauma.

Sustainable Development Goal

Goal 3: Good health and well-being

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