Medical College of Wisconsin
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Thoracostomy tube function not trajectory dictates reintervention. J Surg Res 2016 12;206(2):380-385



Pubmed ID




Scopus ID

2-s2.0-84989958894   2 Citations


BACKGROUND: Hemothorax and/or pneumothorax can be managed successfully managed with tube thoracostomy (TT) in the majority of cases. Improperly placed tubes are common with rates near 30%. This study aimed to determine whether TT trajectory affects the rate of secondary intervention.

METHODS: A retrospective review of all adult trauma patients undergoing TT placement over a 4-y period was performed. TT trajectory was classified as ideal, nonideal, or kinked-based on anterior-posterior chest x-ray. TTs with sentinel port outside the thoracic cavity were excluded. The primary outcome was any secondary intervention.

RESULTS: Four-hundred eighty-six patients and a total of 547 hemithoraces underwent placement and met inclusion criteria. The majority of patients were male (76%), with a median age of 41 y, and majority suffered blunt trauma ideal trajectory was identified in 429 (78.4%). Kinked TTs were noted in 33 (6%) hemothoraces with a 45.5% replacement rate. Review with staff demonstrates inherent bias to replace kinked TTs. The overall secondary intervention rate was 27.8%. Kinked TTs were removed from final analysis due to treatment bias. Subsequent analysis demonstrated no significant difference between ideal and nonideal trajectories (25.1% versus 34.1%, P = 0.09).

CONCLUSIONS: Intrathoracic trajectory of nonkinked TTs with the sentinel port within the thoracic cavity does not affect secondary intervention rates, including the rate of surgical intervention.

Author List

Kugler NW, Carver TW, Knechtges P, Milia D, Goodman L, Paul JS


Thomas W. Carver MD Associate Professor in the Surgery department at Medical College of Wisconsin
Lawrence R. Goodman MD Clinical Professor in the Radiology department at Medical College of Wisconsin
David J. Milia MD Associate Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged, 80 and over
Chest Tubes
Equipment Failure
Follow-Up Studies
Middle Aged
Retrospective Studies
Treatment Outcome
Young Adult
jenkins-FCD Prod-468 69a93cef3257f26b866d455c1d2b2d0f28382f14