Summary
Study of the management of blunt chest wall trauma
Funder: HCRW
Background and study aims
In 2014, in Morriston Hospital in Swansea, 1038 patients with rib injuries (blunt chest trauma) visited Accident and Emergency (A&E). A total of 100 of these patients were admitted to hospital and 13 of these patients died. It can be difficult for doctors in A&E to manage patients who have injured their ribs. A patient will often develop respiratory infections such as pneumonia, but not until approximately 72 hours after they have injured themselves. Doctors need to be able to decide which patients can be sent straight home from A&E, or which patients need to go to a ward or to the Intensive Care Unit (ICU). If the doctor makes the wrong decision, the patient who was sent straight home may develop pneumonia. There would then be a delay in good patient care such as strong pain relief, antibiotics and physiotherapy. This might mean that the patient dies and this has been known to happen. Over the last six years, a simple risk model has been developed and validated that calculates a risk score that the doctors in A&E can then use to decide which patients will develop pneumonia. It also helps the doctor decide where the patient should be managed (for example should they be sent home or go to a ward or to ICU?). In the long term, the aim is to investigate the effectiveness of this risk score. In order to do this, it is necessary to assess whether it helps doctors make the right decisions for patients by making sure they are cared for in the most appropriate place and that they get better as quickly as possible, and if the score saves the NHS valuable resources and money. This aim of this study is to complete a small study to find out whether the different aspects of the main study would be feasible.
Who can participate?
Adult patients with blunt chest trauma who go to A&E of a participating hospital.
What does the study involve?
There are four hospitals taking part, each of whom will collect data for a number of months not using the risk model (just usual care) and then a number of months using the risk model. All patients will be recruited to the trial over a five month data collection period. In both periods, when a patient is admitted to A&E with blunt chest trauma they are asked by the doctor to take part in the study. The patient then is asked to complete a consent form and a short survey. The doctor then either does or does use the risk score to assess the patient (depending on which data collection period they are in). A research nurse then records information about the patient’s hospital stay (if they are admitted). At the end of the study, the number of participants that take part and how well doctors are able to use the risk score is recorded in order to see whether conducting a larger study would be feasible.
What are the possible benefits and risks of participating?
There are no direct benefits or risks involved with participating in this study.
Where is the study run from?
The study is run from Morriston Hospital, Swansea and Swansea Medical School, Swansea University, and takes place at:
1. Royal Gwent Hospital (UK)
2. Musgrove Park Hospital (UK)
3. Manchester Royal Infirmary (UK)
4. Salford Royal Hospital (UK)
When is the study starting and how long is it expected to run for?
October 2016 to September 2018
Contact Details
Trial Manager / Lead Contact: Zoë Abbott
Email: STUMBL@swansea.ac.uk
ISCRTN Number: 95571506;