Nimitt J Patel1, Linda Dultz2, Husayn A Ladhani3, Daniel C Cullinane4, Eric Klein5, Allison G McNickle6, Nikolay Bugaev7, Douglas R Fraser8, Susan Kartiko9, Chris Dodgion10, Peter A Pappas11, Dennis Kim12, Sarah Cantrell13, John J Como14, George Kasotakis15. 1. MetroHealth Medical Center, Case Western Reserve University School of Medicine (CWRU), USA. Electronic address: nimitt.patel.md@gmail.com. 2. UT Southwestern School of Medicine, USA. Electronic address: Linda.Dultz@utsouthwestern.edu. 3. MetroHealth Medical Center, CWRU, USA. Electronic address: husaynladhani@gmail.com. 4. Maine Medical Center, USA. Electronic address: cullinane.daniel@marshfieldclinic.org. 5. Northwell Health, USA. Electronic address: eklein2@northwell.edu. 6. UNLV School of Medicine, USA. Electronic address: Allison.McNickle@unlv.edu. 7. Tufts Medical Center, USA. Electronic address: NBugaev@tuftsmedicalcenter.org. 8. UNLV School of Medicine, USA. Electronic address: douglas.fraser@unlv.edu. 9. George Washington University Hospital, USA. Electronic address: susan.kartiko1@gmail.com. 10. Medical College of Wisconsin School of Medicine, USA. Electronic address: cdodgion@mcw.edu. 11. University of Central Florida College of Medicine, USA. Electronic address: peterpappas52@gmail.com. 12. Harbor-UCLA Medical Center, USA. Electronic address: dennisyongkim@gmail.com. 13. Duke University Medical Center Library & Archives, Duke University School of Medicine, USA. Electronic address: sarah.cantrell@duke.edu. 14. MetroHealth Medical Center, CWRU, USA. Electronic address: jcomo@metrohealth.org. 15. Duke University School of Medicine, USA. Electronic address: george.kasotakis@duke.edu.
Abstract
BACKGROUND: Traumatic hemothorax poses diagnostic and therapeutic challenges both acutely and chronically. A working group of the Eastern Association for the Surgery of Trauma convened to formulate a practice management guideline for traumatic hemothorax. METHODS: We formulated four questions: whether tube thoracostomy vs observation be performed, should pigtail catheter versus thoracostomy tube be placed to drain hemothorax, should thrombolytic therapy be attempted versus immediate thoracoscopic assisted drainage (VATS) in retained hemothorax (rHTX), and should early VATS (≤4 days) versus late VATS (>4 days) be performed? A systematic review was undertaken from articles identified in multiple databases. RESULTS: A total of 6391 articles were identified, 14 were selected for guideline construction. Most articles were retrospective with very low-quality evidence. We performed meta-analysis for some of the outcomes for three of the questions. CONCLUSIONS: For traumatic hemothorax we conditionally recommend pigtail catheters, in hemodynamically stable patients. In patients with rHTX, we conditionally recommend VATS rather than attempting thrombolytic therapy and recommend that it should be performed early (≤4 days).
BACKGROUND:Traumatic hemothorax poses diagnostic and therapeutic challenges both acutely and chronically. A working group of the Eastern Association for the Surgery of Trauma convened to formulate a practice management guideline for traumatic hemothorax. METHODS: We formulated four questions: whether tube thoracostomy vs observation be performed, should pigtail catheter versus thoracostomy tube be placed to drain hemothorax, should thrombolytic therapy be attempted versus immediate thoracoscopic assisted drainage (VATS) in retained hemothorax (rHTX), and should early VATS (≤4 days) versus late VATS (>4 days) be performed? A systematic review was undertaken from articles identified in multiple databases. RESULTS: A total of 6391 articles were identified, 14 were selected for guideline construction. Most articles were retrospective with very low-quality evidence. We performed meta-analysis for some of the outcomes for three of the questions. CONCLUSIONS: For traumatic hemothorax we conditionally recommend pigtail catheters, in hemodynamically stable patients. In patients with rHTX, we conditionally recommend VATS rather than attempting thrombolytic therapy and recommend that it should be performed early (≤4 days).
Authors: Yahya Alwatari; Alexander Simmonds; Dawit Ayalew; Jad Khoraki; Luke Wolfe; Stefan W Leichtle; Michel B Aboutanos; Edgar B Rodas Journal: Eur J Trauma Emerg Surg Date: 2022-01-27 Impact factor: 2.374
Authors: Raphael Sexauer; Shan Yang; Thomas Weikert; Julien Poletti; Jens Bremerich; Jan Adam Roth; Alexander Walter Sauter; Constantin Anastasopoulos Journal: Invest Radiol Date: 2022-04-02 Impact factor: 10.065