Management of simple thoracic injuries at a Level I trauma centre: can primary health care system take over?

Background: Overtriage is a problem for all trauma systems, including the G reek emergency system. In this study we examined the performance of the pri mary care emergency system in the treatment of patients with simple thoraci c injuries, in the area of a Level I hospital. Our aim was to form organiza tional proposals and treatment and referral guidelines in an effort to impr ove the system's performance. Methods: We reviewed the notes of 488 patients with a thoracic injury as th eir main complaint, seen and immediately discharged from the A + E departme nt of a Level I hospital. Results: Falls and road traffic accidents were the most common mechanisms o f injury. The majority of the injuries were rib fractures or rib cage contu sions. Many patients sought medical advice several days after the injury. F ifteen patients required conservative treatment for orthopaedic injuries. C linical examination, X-rays and abdominal ultrasound were the most useful t ests. Conclusions: Detailed clinical examination, time from injury and a chest X- ray usually identifies the patients who can safely be treated in primary he alth care facilities. Simple radiology services (X-ray and US) and training of general practitioners in basic emergency care principals in primary car e health centres would reduce the number of referred patients with simple t horacic injuries. (C) 2000 Elsevier Science Ltd. All rights reserved.