Background
Empyema remains a distressing complication after thoracic injury.
Objective
To identify high-risk factors associated with the development of empyema.
Design
Retrospective cohort review.
Setting
University hospital, level I trauma center.
Patients
Trauma patients who required tube thoracostomy (TT) betweenjanuary 1, 1991, and November 31, 1993 (n=584).
Methods
Data (demographic characteristics, injuries, chest x-ray film reports, and setting of TT) were assessed using a stepwise logistic regression analysis to identify risk factors associated with the development of posttraumatic empyema.
Results
Empyema that required decortication developed in 25 patients (4%). Factors predictive of development of empyema were retained hemothorax (odds ratio, 12.5;95% confidence interval, 0.96-163), pulmonary contusion (odds ratio, 6.3; 95% confidence interval, 1.53-25.8), and multiple chest tube placement (odds ratio, 2.5; 95% confidence interval, 1.91-3.28); factors not predictive of empyema were severity of injury, mechanism of injury, setting in which TT was performed, number of days chest tubes were in place, and antibiotic drugs at the time of TT.
Conclusions
The extent of pulmonary injury (pulmonary contusion) is an important predictor of empyema development. Previously implicated factors such as setting in which a TT was performed and mechanism of injury did not correlate with the development of posttraumatic empyema. Based on the results of our study, we recommend early drainage of the pleural space with video-assisted thoracoscopic techniques in patients at risk of empyema, which may spare them the morbidity of a thoracotomy.
Arch Surg. 1997;132:647-651
