An integrative review was conducted
which enabled the inclusion of a diverse range of study designs
The review process involved a search of the current literature
evaluation and categorisation of the data
and analysis of the groups
A scoping search was conducted in the Medline Database to determine MESH terms appropriate to the research question
A search was conducted of the Cochrane
Medline, EMBASE and CINAHL databases in March 2014 using search terms including
thoracic injuries”, “rib fractures”, “mortality”, “pneumonia
outcome assessment” and “length of stay
includes a full list of search terms and the databases searched
The initial search was performed without language restrictions or limitations to research design
The initial search was limited to studies of humans, adults and from 1990 onwards
This time-frame was chosen due to changes in interventions, including ventilation and surgical fixation based on a better understanding of blunt chest injury pathophysiology
The initial search was limited to blunt chest trauma and did not focus on specific individual injury types
Patient outcomes included complications such as pneumonia, the duration of mechanical ventilation, pain level and mortality
. Health service delivery referred to the access to interventions and the provision of multidisciplinary care, delivery outcomes included cost and hospital length of stay. The search yielded 1107 articles, of which 130 were duplicates
The full text articles were then obtained and reviewed by each author to ensure all inclusion and exclusion criteria were met
Each article was assessed using a quantitative critiquing guideline to assess the quality of the study