Residual Hemothorax after Chest Tube Placement Correlates with Increased Risk of Empyema Following Traumatic Injury

Abstract

The presence of residual hemothorax detected by CXR after tube thoracostomy should prompt further efforts, including thoracoscopy, to drain it. With increasing injury severity, there may be increased benefit in terms of reducing empyema with this approach.

Clinical prediction rule for delayed hemothorax after minor thoracic injury: a multicentre derivation and validation study

“…23 Physicians' practice is highly heterogeneous in the management of minor thoracic injury, with or without rib fractures, especially in terms of discharge follow-up plans and admission. 21 Because hemothorax is associated with important consequences, such as acute respiratory distress syndrome, emphysema, functional limitations, infections and longer lengths of stay in hospital, 20,[37][38][39][40][41] post-emergency planning creates challenges for both health care professionals and patients. It is impossible to follow all patients with minor thoracic injury in overcrowded emergency departments.…”

Suction evacuation of hemothorax

“…1,2,8 The relative frequency of retained hemothorax has resulted in a wealth of literature regarding the best management 8 With empyema incidence documented at 18% after chest tube placement, aggressive preventive measures are warranted. 11 These efforts have included routine follow-up chest CT scans to detect residual blood, placement of additional chest tubes for drainage, installation of thrombolytics into the pleural space to assist with drainage, antibiotics administered at the time of chest tube insertion and early VATS. 3,4,[10][11][12][13][14] The American Association for the Surgery of Trauma Retained Hemothorax Study Group ultimately recommended observation alone if the volume of retained blood was less than 300 cm 3 .…”

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

“…The occurrence of empyema seems to be more highly associated with hemothorax than pneumothorax [19,20] and rates are reported to vary between 4% and 10% [21][22][23]. Empyema is a particularly prevalent risk in the presence of retained hemothorax as the nutrients provided by the remaining blood products are ideal for bacterial growth.…”