Implementation of 300-mL Rule for Management of Traumatic Hemothorax. J Am Coll Surg 2024 Nov 01;239(5):422-429
Date
06/04/2024Pubmed ID
38832690DOI
10.1097/XCS.0000000000001125Scopus ID
2-s2.0-85207664263 (requires institutional sign-in at Scopus site) 3 CitationsAbstract
BACKGROUND: Traumatic hemothorax (HTX) is often managed with tube thoracostomy (TT); however, TT carries a high complication rate. In 2017, a guideline was implemented at our Level I trauma center to observe traumatic HTX 300 mL or less in patients who are hemodynamically stable. We hypothesized that this guideline would decrease TT placement without increasing observation failure rates.
STUDY DESIGN: This was a single-center retrospective review of all adult patients admitted with an HTX on CT before (2015 to 2016) and after (2018 to 2019) the guideline implementation. Exclusion criteria were TT placement before CT scan, absence of CT scan, death within 5 days of admission, and a concurrent pneumothorax more than 20 mm. HTX volume was calculated using CT scan images and Mergo's formula: V = d2 × L (where V is the volume, d is the depth, and L is the length). The primary outcome was observation failure, defined as the need for TT, video-assisted thoracoscopic surgery, thoracotomy after repeat imaging or worsening of symptoms, and pulmonary morbidity.
RESULTS: A total of 357 patients met inclusion criteria, of whom 210 were admitted after guideline implementation. No significant differences in baseline demographics, comorbidities, or injury characteristics across both cohorts were observed. The postimplementation cohort had a significant increase in observation rate (75% vs 59%) and a decrease in TT placement (42% vs 57%). The postimplementation group had a statistically significant shorter hospital (6 vs 8 days) and ICU (2 vs 3 days) length of stay. No significant differences in observation failure, pulmonary complications, 30-day readmission, or 30-day mortality were observed across both cohorts.
CONCLUSIONS: The implementation of the 300-mL guideline led to a decrease in TT placement without increasing observation failure or complication rates.
Author List
Al Tannir AH, Biesboer EA, Tentis M, Seadler M, Patin BB, Golestani S, Morris RS, Peschman J, Carver TW, de Moya MAAuthors
Thomas W. Carver MD Professor in the Surgery department at Medical College of WisconsinSimin Golestani MD Instructor in the Surgery department at Medical College of Wisconsin
Rachel S. Morris MD Assistant Professor in the Surgery department at Medical College of Wisconsin
Jacob R. Peschman MD Associate Professor in the Surgery department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdultChest Tubes
Female
Hemothorax
Humans
Male
Middle Aged
Practice Guidelines as Topic
Retrospective Studies
Thoracic Injuries
Thoracic Surgery, Video-Assisted
Thoracostomy
Tomography, X-Ray Computed
Trauma Centers
