Complications of tube thoracostomy in trauma

Abstract

Objective-To assess the complication rate of tube thoracostomy in trauma. To consider whether this rate is high enough to support a selective reduction in the indications for tube thoracostomy in trauma. Methods-A retrospective case series of all trauma patients who underwent tube thoracostomy during a 12 month period at a large UK teaching hospital with an accident and emergency (A&E) department seeing in excess of 125 000 new patients/ year. These patients were identified using the hospital audit department computerised retrieval system supplemented by a hand search of both the data collected for the Major Trauma Outcome Study and the A&E admission unit log book. The notes were assessed with regard to the incidence of complications, which were divided into insertional, infective, and positional. Results-Fifty seven chest drains were placed in 47 patients over the 12 month period. Seven patients who died within 48 hours of drain insertion were excluded. The commonest indications for tube thoracostomy were pneumothorax (54%) and haemothorax (20%); 90% of tubes were placed as a result of blunt trauma. The overall complication rate of the procedure was 30%. There were no insertional complications and only one (2%) major complication, which was empyema thoracis. Conclusion-This study reveals no persuasive evidence to support a selective reduction in the indications for tube thoracostomy in trauma. A larger study to confirm or refute these findings must be performed before any change in established safe practice.

The analysis of 89 patients that performed tube thoracostomy by general surgeons

“…In several studies, the rate of complications was reported to vary between 4.8% and 30% (16)(17)(18)(19)(20), consistent with our study findings (2.2%). Duration of the removal of the tube, length of hospital stay, and development of complications related to the thoracic tube have been associated with severity of injury.…”

Lateral Thoracostomy Tubes: Is Outcome Affected by Level of Intercostal Space?

“…Outcome variables measured included indication for tube placement, chest tube interval (CTI), length of hospital stay (LOHS), mortality, the need for any related intervention (replacement, adjustment of malposition, placement of second chest tube), and the need for surgical intervention (Video-assisted thoracoscopic surgery (VATS), Thoracotomy) and complications. Similarly to the study performed by Bailey, complications were classified as insertional, positional, or infective [3]. Demographic data studied included age, race, gender, injury class and mechanism, prior injuries, Injury…”

“…Infections, when they occur, have a tendency to be drain site infections which are minor in nature. Clinically major infections such as an empyema have a relatively low incidence rate [3]. While lateral placement seems to be preferred by most physicians, there is no clinically significant difference between ventral and lateral placement of chest tubes [4].…”

Common iatrogenic pleural complications

“…Chest drain insertions carry a 2%-3% risk [31], but this is increased in the context of trauma [32]. Empirical antibiotics have been shown to be beneficial in reducing the incidence of pleural infection when a chest drain is inserted for trauma [33•, 34]; however, outside this context, there have been no clinical trials evaluating their use and they are not routinely given.…”