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Acute minor thoracic injuries: evaluation of practice and follow-up in the emergency department.

OBJECTIVE: To review the management and follow-up of patients with minor thoracic injuries (MTI) treated by emergency or primary care physicians.

DESIGN: A multicentre, retrospective study.

SETTING: Three university-affiliated emergency departments of the metropolitan region of Quebec city, Que.

PARTICIPANTS: Patients older than 16 years of age with suspected or proven rib fractures following traumatic events.

MAIN OUTCOME MEASURES: Differences in admission and discharge proportions and disposition management following MTI.

RESULTS: Four hundred and forty-seven charts were analyzed. Only 23 patients (5.2%) were admitted during the study period. Admission and discharge proportions were significantly different among the 3 surveyed hospitals, ranging from 1.3% to 15.2% (P < or = .001). There were no recommendations of follow-up noted in most (53.5%) of the charts and there were no differences after hospital stratification. Planned follow-up visits were scheduled for 5.7% of discharged patients. Being older than 65 years of age or having multiple rib fractures had no influence on management and follow-up recommendations. Eighty-two patients (18.6%) had unplanned follow-up visits in the emergency department, with inadequate pain relief as the principal reason for consultation (56.1%). There was no significant difference after stratification for age and type of analgesia. Other clinically significant delayed complications were recorded in 8.3% of all MTI patients.

CONCLUSION: The proportion of patients admitted for rib fractures was lower than the expected 25%, based on previous publications, and varied across surveyed hospitals. A very low proportion of patients was offered planned follow-up visits or even any follow-up recommendations in view of possible delayed complications and disabilities. Further studies are needed to identify predictors of delayed MTI complications and enhance appropriate use of follow-up resources.

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