Predictors of retained hemothorax after trauma and impact on patient outcomes

Scott, Mark F.; Khodaverdian, R; Shaheen, J. L.; Ney, Arthur L.; Nygaard, Rachel M

doi:10.1007/s00068-015-0604-y

Cited by 21 publications

(9 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The risk factors for development of retained hemothorax include presence of bilateral thoracic injuries, need for intubation on the day of admission and higher Injury severity score (ISS). 9 High initial output from chest tube, number and duration of chest tube drainage also determine the risk for retained hemothorax. However, the position of tube relative to lung parenchyma or high chest tube placement did not determine the need for secondary intervention.…”

Section: Retained Hemothoraxmentioning

confidence: 99%

Traumatic retained hemothorax: is it time for video assisted thoracoscopic surgery

et al. 2020

View full text Add to dashboard Cite

Thoracic trauma is a significant cause of morbidity and mortality, if not treated promptly. 80% to 85% of chest injuries can be treated with chest tube insertion alone. However, in about four to 20% of population, there is incomplete clearance of hemothorax following tube insertion and can lead to a condition called retained hemothorax. The purpose of this review is to establish the role and effectiveness of Video assisted thoracoscopic surgery (VATS) in successful evacuation of retained hemothorax following blunt thoracic trauma. Relevant articles from databases like Pubmed, Google scholar, Medline and Cochrane library were included. A retained hemothorax is defined as the persistence of residual clots in the pleural cavity, which is radiologically evident, 72 hours following initial tube thoracostomy. The various options to manage this condition include observation, insertion of second thoracostomy tube, intrapleural fibrinolytic, VATS or thoracotomy. Based on review of existing studies, VATS evacuation was found to have shorter hospital stay, lesser costs and shorter duration of tube drainage. There was also lesser rate of conversion to thoracotomy as compared to other methods and fewer complications like fibrothorax and empyema. In hemodynamically unstable patients, which is a contraindication to VATS, use of intrapleural fibrinolytics like streptokinase may be considered as an alternative option to provide clearance of the retained hemothorax. Retained hemothorax, when encountered following thoracic trauma, can be effectively managed by VATS. The decision to use VATS for hemothorax evacuation should be made promptly for maximum results, especially within three to seven days following trauma.

show abstract

Section: Retained Hemothoraxmentioning

confidence: 99%

Traumatic retained hemothorax: is it time for video assisted thoracoscopic surgery

et al. 2020

View full text Add to dashboard Cite

show abstract

“…1,2,[5][6][7] Risk factors for the development of RH include high initial TT blood output, number of TT placed, and duration of TT. 10,11 In addition, higher injury severity score (ISS), presence of bilateral thoracic injuries, and need for mechanical ventilation have also been associated with the risk for developing RH. 10 The complications and consequences of RH are not insignificant, as it is a known risk factor for pneumonia, and pleural space complications such as empyema and fibrothorax, which pose significant morbidity and possible mortality to the patient.…”

Section: Etiology/risk Factorsmentioning

confidence: 99%

“…10,11 In addition, higher injury severity score (ISS), presence of bilateral thoracic injuries, and need for mechanical ventilation have also been associated with the risk for developing RH. 10 The complications and consequences of RH are not insignificant, as it is a known risk factor for pneumonia, and pleural space complications such as empyema and fibrothorax, which pose significant morbidity and possible mortality to the patient. 1,2,6,9,12 Diagnosis A plain CXR is easily obtained and is commonly used for examination and surveillance of patients with thoracic pathology.…”

Section: Etiology/risk Factorsmentioning

confidence: 99%

Section: Etiology/risk Factorsmentioning

confidence: 99%

“…1,4 Retained hemothorax (RH) is a known sequelae of traumatic HTX but the exact incidence varies in the literature, ranging from 4% to 20% 1,2,[4][5][6][7] and is associated with significant morbidity as well as increased costs and burden to the healthcare system. [8][9][10] There is continuing interest in determining how to best treat RH and this expert narrative review examines the etiology, risk factors, diagnosis, management, and complications associated with RH. An algorithm for the approach to managing a retained hemothorax is proposed.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Management of post-traumatic retained hemothorax

Bozzay

Bradley

2018

Trauma

View full text Add to dashboard Cite

Introduction: Chest injuries occur in a significant portion of trauma patients and hemothorax is a common result. While the initial management of traumatic hemothorax is most commonly treated with tube thoracostomy, the management of retained hemothorax is a subject of debate. Recent literature has proposed different methods for treating or preventing retained hemothorax, yet the approach to this pathology is not straightforward. Methods: The literature was reviewed for relevant studies regarding the prevention and management of post-traumatic retained hemothorax. What follows is a review of the recent literature and an algorithm for the approach to treating a traumatic retained hemothorax. Results: Identifying a traumatic retained hemothorax and preventing subsequent complications such as pneumonia, empyema, and fibrothorax are significant issues faced by surgeons. Studies for preventing retained hemothorax have focused on initial chest tube size, location, and peri-procedural placement conditions, as well as thoracic lavage. Several treatment modalities exist, including second drainage procedure and intra-pleural fibrinolytic drug instillation, but videoassisted thoracoscopic surgery is the most common and successful approach. Regardless of the approach to evacuation, early intervention is paramount. Conclusion: Further studies will help characterize appropriate candidates, timing, treatment modalities, and guide therapy for retained hemothorax.

show abstract