Tube thoracostomy. Factors related to complications
S. W. Etoch, M. F. Bar-Natan, F. B. Miller and J. D. Richardson
Department of Surgery, University of Louisville, School of Medicine, KY, USA.
OBJECTIVE: To determine the complication rate and risk factors associated
with tube thoracostomy (TT) in the trauma patient. DESIGN: Retrospective
hospital chart review. SETTING: Level I trauma center. PATIENTS: Four
hundred twenty-six consecutive patients who underwent TT were initially
reviewed; 47 deaths occurred unrelated to TT placement. The remaining 379
patients required 599 tubes and composed the study population. MAIN OUTCOME
MEASURES: The determination of adverse outcomes related to TT, including
thoracic empyema, undrained hemothorax or pneumothorax, improper tube
positioning, post-tube removal complications, and direct injuries to the
lung. RESULTS: The overall complication rate was 21% per patient. Although
complications were not related to the Injury Severity Score, the presence
of shock, admission to the intensive care unit, and the need for mechanical
ventilation were associated with the increased incidence of complications.
There were fewer complications (6%) when the TT was performed by a surgeon
compared with TT performed by an emergency physician (13%, P < .0001) or
TT performed prior to transfer to our hospital (38%, P < .0001).
CONCLUSIONS: Tube thoracostomy is associated with significant morbidity.
The striking difference in the complication rate between surgeons and other
physicians who perform this procedure suggests that additional training may
be indicated.
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