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

This is the authors' abstract. We don't add key points for this paper.

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.