Does reduced cough capacity in minor thoracic injury is associated with atelectasis development?

Context Minor thoracic injury causes non-negligible pain that could reduce the cough capacity and can cause infectious problems and atelectasis. Objectives: To describe the association between atelectasis and cough capacity, and to assess the concordance of cough capacity perceptions between health professionals and the patient. Design: The data were collected from 2006 to 2012 in 4 Canadian emergency departments (ED). Participants Patients with a chief complaint of minor thoracic injury, ≥ 16 years old, discharged home from the ED after an evaluation by the attending physician, were included. They have three visits, at the ED, 7-day and 14-day follow-up. The initial ED visit included medical evaluation, data collection and mandatory chest and rib radiography. Main outcome measures The presence of atelectasis was noted at the initial ED and subsequent visits.Participants cough capacity was noted by a physician, a nurse and the patients himself at subsequentvisits and classified as good, diminished, weak /absent. Results: Among the 1474 patients, 8.89% (95% CI: 7.55 - 10.47), 7.33% (95% CI: 6.04 – 8.89) and 4.63% (95% CI: 3.51 – 6.09) had atelectasis at the initial visit, 7-day and 14-day follow-up visit respectively. Except for patients with weak or absent cough capacity at the 7-day visit, which had a 2.89 (95%CI: 2.05 – 4.05) folds atelectasis proportion relative to those with a good cough capacity, they were no associations between cough capacity and atelectasis. The weighted kappa coefficient suggests a moderate to substantial agreement between the cough capacity measured by patients and nurses (0.52 to 0.65). Conclusion: There was not strong evidence of an association between atelectasis and cough capacity and the best agreement between cough capacity perception was between nurses and patients.