The long-term outcomes and health-related quality of life of patients following blunt thoracic injury: a narrative literature review

Edward Baker, Andreas Xyrichis, Christine Norton, Philip Hopkins, Geraldine Lee

Major Trauma remains a leading cause of mortality and morbidity worldwide. Blunt Thoracic Injury (BTI) accounts for > 15% of United Kingdom (UK) trauma admissions and is consistently associated with respiratory related complications that include pneumonia and respiratory failure. Despite this, it is unclear in current clinical practice how BTI impacts on the recovering trauma patients after discharge from hospital. This study aimed to investigate the state of knowledge on the impact of BTI on the long-term outcomes and health-related quality of life (HRQoL). Data were sourced from Ovid MEDLINE, Ovid EMBASE, CINAHL and Science Direct using a pre-defined systematic search strategy. A subsequent hand search of key references was used to identify potentially missed studies. Abstracts were screened for eligibility and inclusion. Fifteen studies met the eligibility criteria and were critically appraised. Data were extracted, analysed and synthesised in categories and sub-categories following a narrative approach. Three major themes were identified from the 15 studies included in this review: (i) physical impact of BTI, (ii) psychological impact of BTI and (iii) socio-economic impact of BTI. The bulk of the available data focused on the physical impact where further sub-themes included: (i) physical functioning, (ii) ongoing unresolved pain, (iii) reduced respiratory function, (iv) thoracic structural integrity. Although there was a substantial difference in the length and method of follow up, there remains a general trend towards physical symptoms improving over time, particularly over the first six months after injury. Despite this, where sequelae continued at six months it remained likely that these would also be present at two years after injury. The literature review demonstrated that BTI is associated with substantial sequelae that impacts on all aspects of daily functioning. Despite this there remains a paucity of data relating to long term outcomes in the BTI population, especially relating to psychological and socio-economic impact. There is also little consensus on the measures, tools and time-frames used to measure outcomes and HRQoL in this population. The full impact of BTI on this population needs further exploration.