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 Greek emergency system. In this study we examined the performance of the primary care emergency system in the treatment of patients with simple thoracic injuries, in the area of a Level I hospital. Our aim was to form organizational proposals and treatment and referral guidelines in an effort to improve the system's performance. Methods: We reviewed the notes of 488 patients with a thoracic injury as their main complaint, seen and immediately discharged from the A + E department of a Level I hospital. Results: Falls and road traffic accidents were the most common mechanisms of injury. The majority of the injuries were rib fractures or rib cage contusions. Many patients sought medical advice several days after the injury. Fifteen patients required conservative treatment for orthopaedic injuries. Clinical examination, X-rays and abdominal ultrasound were the most useful tests. Conclusions: Detailed clinical examination, time from injury and a chest X-ray usually identifies the patients who can safely be treated in primary health care facilities. Simple radiology services (X-ray and US) and training of general practitioners in basic emergency care principals in primary care health centres would reduce the number of referred patients with simple thoracic injuries. (C) 2000 Elsevier Science Ltd. All rights reserved.