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, 2:642

Medicine

Abstract

IntroductionThe management and removal of thoracostomy tubes for trauma-related hemothorax and pneumothorax is controversial. General recommendations exist; however, institutional data related to an algorithmic approach has not been well described. The difficulty in establishing an algorithm centers about individualized patients’ needs for subsequent management after thoracostomy tube placement. In our institution, we use the same protocol for all trauma patients who receive a thoracostomy tube with minimal complications.

PurposeTo present the clinical outcomes of patients who required a tube thoracostomy for traumatic injury and were managed by an institutional protocol.

MethodsA retrospective chart review of 313 trauma patients at a single level I trauma institution from January 2008 through June 2012 was conducted. Inclusion criteria were patient age ≥ 18 years, involvement in a trauma, and requirement of a thoracostomy tube. The patients’ charts were reviewed for demographic data, injury severity score ISS, length of stay LOS, and chest-tube specific data. Thoracostomy tube complications were defined as persistent air leak, persistent pneumothorax, recurrent pneumothorax, and clotting of thoracostomy tube. The patients were managed per our institutional algorithm. Descriptive statistics were performed.

ResultsMost of the patients who required a thoracostomy tube had blunt-related traumas 271-313; 86.6%, while 42 patients 13.4% sustained penetrating injuries. There were 215 68.7% male patients. The average age at time of injury was 45.7 ± 21.1 years and the mean ISS was 24.9 ± 15.9 mean ± SD. Elevated alcohol levels were found in 65 of the 247 patients who were tested upon admission 26.3%. Overall, 15 patients 4.8% developed a thoracostomy tube related complication: persistent air leak in six patients, persistent pneumothorax in six patients, recurrent pneumothorax in two patients, and clotted thoracostomy tube in one patient. The average LOS was 10.4 ± 8.4 days, and the mean length of thoracostomy tube placement was 5.9 ± 4.3 days.

ConclusionsOur algorithmic thoracostomy tube management protocol resulted in a complication rate of 4.8%. By managing thoracostomy tubes in a systematic manner, our patients have improved outcomes following placement and removal compared to other studies.

KeywordsTube thoracostomy Algorithm Guideline Pneumothorax Hemothorax Outcomes AbbreviationsISSInjury severity score

PTXPneumothorax

CXRChest x-ray

ATLSAdvanced Trauma Life Support

CTComputed tomography.

Electronic supplementary materialThe online version of this article doi:10.1186-2193-1801-2-642 contains supplementary material, which is available to authorized users.

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Autor: Mersadies Martin - Cory T Schall - Cheryl Anderson - Nicole Kopari - Alan T Davis - Penny Stevens - Pam Haan - John P K

Fuente: https://link.springer.com/



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