Can Concurrent Traumatic Hemopneumothorax be Safely Observed? J Surg Res 2024 Dec;304:400-407
Date
10/26/2024Pubmed ID
39455348DOI
10.1016/j.jss.2024.09.085Scopus ID
2-s2.0-85207735852 (requires institutional sign-in at Scopus site)Abstract
INTRODUCTION: The cooccurrence of a traumatic hemothorax (HTX) and pneumothorax (PTX) is extremely common (70%). Prior work shows the safety of observing small HTX (≤300 cubic centimeters) and PTX (≤35 mm) in isolation. Accordingly, we sought to assess the safety of observation of concurrent small hemopneumothorax(HPTX).
METHODS: We conducted a single-center retrospective study from 2015 to 2021 at a level I trauma center. Patients with a computed tomography (CT) scan confirmed that HPTXwas included in the study. Exclusion criteria included tube thoracostomy (TT) prior to CT scan, TT placement for rib fixation, PTX>35 mm, HTX>300 cubic centimeters, and death within 72 h of admission. The study group was stratified into either initial observation or early TT, which is defined as TT placement immediately after initial CT scan. Primary outcome was observation failure.
RESULTS: A total of 353 patients met the inclusion criteria, of whom 261 (74%) were initially observed. The initial observation cohort had a lower pulmonary morbidity rate (9% versus 14%; P = 0.04) and a shorter hospital (7 versus 10 d, P < 0.001) and intensive care unit (2 versus 4 d, P = 0.01) length of stay (LOS) when compared to those with initial TT placement. Sixty-eight (26%) patients failed observation, with a worsening HTXon repeat imaging (45%) being the most common reason. Compared to those who received an early TT, those who failed observation had a similar pulmonary morbidity and need for video-assisted thoracoscopic surgery, TT duration, LOS, readmission, and mortality rates.
CONCLUSIONS: Initial observation of concurrent small traumatic HPTX had a lower pulmonary morbidity and LOS but was found to have a clinically significant failure rate. Patients who failed observation had similar outcomes to those who received an early TT.
Author List
Al Tannir AH, Tentis M, Maring M, Patin B, Biesboer EA, Golestani S, Pokrzywa CJ, Peschman J, Murphy PB, Morris RS, Carver TW, de Moya MAAuthors
Thomas W. Carver MD Professor in the Surgery department at Medical College of WisconsinRachel S. Morris MD Associate 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
Courtney J. Pokrzywa MD Instructor in the Surgery department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdultFemale
Hemopneumothorax
Hemothorax
Humans
Length of Stay
Male
Middle Aged
Pneumothorax
Retrospective Studies
Thoracic Injuries
Thoracostomy
Tomography, X-Ray Computed
Trauma Centers
Watchful Waiting
Young Adult
