M I Villegas1,2, R A Hennessey3, C H Morales4,5, E Londoño6. 1. Department of Surgery, Universidad de Antioquia, Medellin, Colombia. mivillegas@une.net.co. 2. Hospital Universitario San Vicente de Paul, Calle 64 N° 51, Medellin, Colombia. mivillegas@une.net.co. 3. Department of Surgery, Universidad de Antioquia, Medellin, Colombia. rchiryae@hotmail.com. 4. Department of Surgery, Universidad de Antioquia, Medellin, Colombia. cmorales@une.net.co. 5. Hospital Universitario San Vicente de Paul, Calle 64 N° 51, Medellin, Colombia. cmorales@une.net.co. 6. Department of Surgery, Universidad de Antioquia, Medellin, Colombia. elmolinares@hotmail.com.
Abstract
OBJECTIVE: To identify risk factors associated with the development of post-traumatic retained hemothorax in chest trauma patients admitted to Hospital San Vicente de Paul (HUSVP). METHODS: This study was a prospective cohort study that included patients with a diagnosis of chest trauma who required a tube thoracostomy as a therapeutic intervention. The measured outcome was retained hemothorax, defined as the presence of blood in the pleural cavity that could not be drained through the initial tube thoracostomy and appeared radio-opaque or hypodense on X-rays or CT scan. The postoperative follow-up period was 30 days. RESULTS: Six hundred thirty-three thoracostomies were performed over a 28-month period for chest trauma; the incidence of post-traumatic retained hemothorax was 16.7%, and additional complications were seen in 10% of cases. The risk of retained hemothorax was associated with: initial blood drainage (median, 400 ml; p < 0.001), the number of tubes placed (two or more; OR = 5.35, CI 95%: 3.98-7.20), the duration of the tube thoracostomy (median, 5 days; p = 0.01), and the need for mechanical ventilation (RR = 2.5, CI 95%: 1.66-3.75). CONCLUSIONS: The risk of post-traumatic retained hemothorax was associated with four factors. The probability of the outcome could be modified by careful monitoring, management protocols, suction through the tube thoracostomy, and maybe an early intervention, such as thoracoscopy.
OBJECTIVE: To identify risk factors associated with the development of post-traumatic retained hemothorax in chest traumapatients admitted to Hospital San Vicente de Paul (HUSVP). METHODS: This study was a prospective cohort study that included patients with a diagnosis of chest trauma who required a tube thoracostomy as a therapeutic intervention. The measured outcome was retained hemothorax, defined as the presence of blood in the pleural cavity that could not be drained through the initial tube thoracostomy and appeared radio-opaque or hypodense on X-rays or CT scan. The postoperative follow-up period was 30 days. RESULTS: Six hundred thirty-three thoracostomies were performed over a 28-month period for chest trauma; the incidence of post-traumatic retained hemothorax was 16.7%, and additional complications were seen in 10% of cases. The risk of retained hemothorax was associated with: initial blood drainage (median, 400 ml; p < 0.001), the number of tubes placed (two or more; OR = 5.35, CI 95%: 3.98-7.20), the duration of the tube thoracostomy (median, 5 days; p = 0.01), and the need for mechanical ventilation (RR = 2.5, CI 95%: 1.66-3.75). CONCLUSIONS: The risk of post-traumatic retained hemothorax was associated with four factors. The probability of the outcome could be modified by careful monitoring, management protocols, suction through the tube thoracostomy, and maybe an early intervention, such as thoracoscopy.
Authors: M Blair Marshall; Maher E Deeb; Joshua I S Bleier; John C Kucharczuk; Joseph S Friedberg; Larry R Kaiser; Joseph B Shrager Journal: Chest Date: 2002-03 Impact factor: 9.410