S Kumar1, V Rathi2, A Rattan3, S Chaudhary4, N Agarwal1. 1. Department of General Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, New Delhi 95, India. 2. Department of Radio-diagnosis, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, New Delhi 95, India. 3. Department of Trauma Surgery, JPN Apex Trauma Center, AIIMS, New Delhi 29, India. Electronic address: amulyarattan@rediffmail.com. 4. Department of Anethesiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, New Delhi 95, India.
Abstract
BACKGROUND:Post-traumatic residual haemothorax (RH) is common and carries significant morbidity. However, its optimal treatment is not clear. AIM: The aim of this study was to find the extent of this problem and the choice of treatment between VATS and intra-pleural streptokinase instillation (IPSI). MATERIAL AND METHODS: This RCT, conducted over 18 months period, included all patients of chest trauma between 18 and 70 years of age, admitted with haemothorax or haemopneumothorax requiring inter-costal drain (ICD) insertion. 154 events of haemothorax/haemopneumothorax requiring ICD insertion were enrolled. RH was seen in 48 (31%) patients: 13 patients were excluded from RCT after refusal for treatment. Seventeen (49%) patients of remaining 35 RH cases were randomized to IPSI group and 18 (51%) patients were randomized to VATS group. The outcome parameters were resolution of RH and treatment related complications. RESULTS:RH resolved equally well in VATS and IPSI group [13 patients (72%) versus 12 patients (71%), respectively; continuity-adjusted p=1]. Morbidity wise no difference (p-value 0.529) was seen in the two groups. CONCLUSION: Post-traumatic RH is seen in 1/3rd patients and is equally well treated by VATS and IPSI.
RCT Entities:
BACKGROUND: Post-traumatic residual haemothorax (RH) is common and carries significant morbidity. However, its optimal treatment is not clear. AIM: The aim of this study was to find the extent of this problem and the choice of treatment between VATS and intra-pleural streptokinase instillation (IPSI). MATERIAL AND METHODS: This RCT, conducted over 18 months period, included all patients of chest trauma between 18 and 70 years of age, admitted with haemothorax or haemopneumothorax requiring inter-costal drain (ICD) insertion. 154 events of haemothorax/haemopneumothorax requiring ICD insertion were enrolled. RH was seen in 48 (31%) patients: 13 patients were excluded from RCT after refusal for treatment. Seventeen (49%) patients of remaining 35 RH cases were randomized to IPSI group and 18 (51%) patients were randomized to VATS group. The outcome parameters were resolution of RH and treatment related complications. RESULTS: RH resolved equally well in VATS and IPSI group [13 patients (72%) versus 12 patients (71%), respectively; continuity-adjusted p=1]. Morbidity wise no difference (p-value 0.529) was seen in the two groups. CONCLUSION: Post-traumatic RH is seen in 1/3rd patients and is equally well treated by VATS and IPSI.
Authors: Aladdin Bashir; Omar Daraghma; Zbigniew Brzeziński; Dawid Imiełowski; Piotr Daszkiewicz; Witold Gwoźdź; Jerzy Stupała; Paweł Tomaszewski; Jacek Kaperczak Journal: Kardiochir Torakochirurgia Pol Date: 2017-09-30