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Natural history of a postpull pneumothorax or effusion: observation is safe. J Trauma Acute Care Surg 2015 Feb;78(2):391-5

Date

03/11/2015

Pubmed ID

25757127

DOI

10.1097/TA.0000000000000525

Scopus ID

2-s2.0-84925843923   3 Citations

Abstract

BACKGROUND: Thoracostomy tube (TT) for drainage of hemopneumothorax is the most common intervention in thoracic trauma. Postpull pneumothorax or effusion (PPP/PPE) is common after removal of a TT. The natural history of PPP/PPE after discharge has not been described. This study evaluates the outcomes and management of PPP/PPE after discharge.

METHODS: Trauma patients with TT placed from July 1, 2008, to June 30, 2013, were identified from an administrative database and trauma registry. PPP/PPE was defined as the presence of air or fluid in the chest on a postpull imaging. The electronic medical record and final radiology interpretation were reviewed to confirm PPP/PPE during index admission and at discharge. Clinical follow-up and imaging were reviewed for the presence of persistent PPP/PPE. Interventions directed toward PPP/PPE and readmissions were recorded for patients with and without a PPP/PPE. Multivariate logistic regression was performed to identify factors for chest-related readmission.

RESULTS: Seven hundred ten patients surviving to discharge had a TT placed during the study time frame. Of the 151 patients (21.3%) with documented PPP/PPE on discharge, 115 patients had follow-up data available. Outpatient imaging was obtained in 35 patients, with persistent PPP/PPE noted in 16 patients (45.7%). Six patients (4%) with PPP/PPE at discharge required reintervention. Patients without documented PPP/PPE at discharge had a lower readmission rate (0.7% vs. 6.6%, p = 0.02). Multivariate logistic regression noted the presence of persistent PPP/PPE at follow-up (p = 0.001) to be associated with readmission.

CONCLUSION: PPP/PPE is a common occurrence following removal of a TT. While patients discharged with PPP/PPE have a statistically higher reintervention rate, the absolute value remains low. This should be considered when treating clinically stable, asymptomatic PPP/PPE.

LEVEL OF EVIDENCE: Epidemiologic study, level IV.

Author List

Kugler NW, Milia DJ, Carver TW, O'Connell K, Paul J

Authors

Thomas W. Carver MD Associate Professor in the Surgery 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

Adult
Chest Tubes
Device Removal
Diagnostic Imaging
Drainage
Female
Humans
Injury Severity Score
Male
Middle Aged
Pleural Effusion
Pneumothorax
Registries
Retreatment
Risk Factors
Thoracic Injuries
Thoracostomy
Trauma Centers
Treatment Outcome
jenkins-FCD Prod-387 b0ced2662056320369de4e5cd5f21c218c03feb3