Sarah Kourouche1, Thomas Buckley2, Belinda Munroe3, Kate Curtis4. 1. Faculty of Nursing and Midwifery (Sydney Nursing School), The University of Sydney, Mallet St., Camperdown, NSW, Australia. Electronic address: sarah.kourouche@sydney.edu.au. 2. Faculty of Nursing and Midwifery (Sydney Nursing School), The University of Sydney, Mallet St., Camperdown, NSW, Australia. Electronic address: tom.buckley@sydney.edu.au. 3. Faculty of Nursing and Midwifery (Sydney Nursing School), The University of Sydney, Mallet St., Camperdown, NSW, Australia; Emergency Services, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Crown St., Wollongong, NSW, Australia. Electronic address: Belinda.Munroe@health.nsw.gov.au. 4. Faculty of Nursing and Midwifery (Sydney Nursing School), The University of Sydney, Mallet St., Camperdown, NSW, Australia; The George Institute for Global Health, Bridge Street, Sydney, NSW, Australia; Emergency Services, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Crown St., Wollongong, NSW, Australia. Electronic address: kate.curtis@sydney.edu.au.
Abstract
BACKGROUND: Blunt chest injuries (BCI) are associated with high rates of morbidity and mortality. There are many interventions for BCI which may be able to be combined as a care bundle for improved and more consistent outcomes. OBJECTIVE: To review and integrate the BCI management interventions to inform the development of a BCI care bundle. METHODS: A structured search of the literature was conducted to identify studies evaluating interventions for patients with BCI. Databases MEDLINE, CINAHL, PubMed and Scopus were searched from 1990-April 2017. A two-step data extraction process was conducted using pre-defined data fields, including research quality indicators. Each study was appraised using a quality assessment tool, scored for level of evidence, then data collated into categories. Interventions were also assessed using the APEASE criteria then integrated to develop a BCI care bundle. RESULTS: Eighty-one articles were included in the final analysis. Interventions that improved BCI outcomes were grouped into three categories; respiratory intervention, analgesia and surgical intervention. Respiratory interventions included continuous positive airway pressure and high flow nasal oxygen. Analgesia interventions included regular multi-modal analgesia and paravertebral or epidural analgesia. Surgical fixation was supported for use in moderate to severe rib fractures/BCI. Interventions supported by evidence and that met APEASE criteria were combined into a BCI care bundle with four components: respiratory adjuncts, analgesia, complication prevention, and surgical fixation. CONCLUSIONS: The key components of a BCI care bundle are respiratory support, analgesia, complication prevention including chest physiotherapy and surgical fixation.
BACKGROUND: Blunt chest injuries (BCI) are associated with high rates of morbidity and mortality. There are many interventions for BCI which may be able to be combined as a care bundle for improved and more consistent outcomes. OBJECTIVE: To review and integrate the BCI management interventions to inform the development of a BCI care bundle. METHODS: A structured search of the literature was conducted to identify studies evaluating interventions for patients with BCI. Databases MEDLINE, CINAHL, PubMed and Scopus were searched from 1990-April 2017. A two-step data extraction process was conducted using pre-defined data fields, including research quality indicators. Each study was appraised using a quality assessment tool, scored for level of evidence, then data collated into categories. Interventions were also assessed using the APEASE criteria then integrated to develop a BCI care bundle. RESULTS: Eighty-one articles were included in the final analysis. Interventions that improved BCI outcomes were grouped into three categories; respiratory intervention, analgesia and surgical intervention. Respiratory interventions included continuous positive airway pressure and high flow nasal oxygen. Analgesia interventions included regular multi-modal analgesia and paravertebral or epidural analgesia. Surgical fixation was supported for use in moderate to severe rib fractures/BCI. Interventions supported by evidence and that met APEASE criteria were combined into a BCI care bundle with four components: respiratory adjuncts, analgesia, complication prevention, and surgical fixation. CONCLUSIONS: The key components of a BCI care bundle are respiratory support, analgesia, complication prevention including chest physiotherapy and surgical fixation.
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