Background: Post-traumatic residual haemothorax (RH) is common and carries significant morbidity. However, its optimal treatment is not clear.
Aim: The aim of this study was to find the extent of this problem and the choice of treatment between VATS and intra-pleural streptokinase instillation (IPSI).
Material and methods: This RCT, conducted over 18 months period, included all patients of chest trauma between 18 and 70 years of age, admitted with haemothorax or haemopneumothorax requiring inter-costal drain (ICD) insertion. 154 events of haemothorax/haemopneumothorax requiring ICD insertion were enrolled. RH was seen in 48 (31%) patients: 13 patients were excluded from RCT after refusal for treatment. Seventeen (49%) patients of remaining 35 RH cases were randomized to IPSI group and 18 (51%) patients were randomized to VATS group. The outcome parameters were resolution of RH and treatment related complications.
Results: RH resolved equally well in VATS and IPSI group [13 patients (72%) versus 12 patients (71%), respectively; continuity-adjusted p=1]. Morbidity wise no difference (p-value 0.529) was seen in the two groups.
Conclusion: Post-traumatic RH is seen in 1/3rd patients and is equally well treated by VATS and IPSI.
Keywords: Chest trauma; Haemothorax; Intercostal drainage; Intrapleural streptokinase; Residual haemothorax; Retained haemothorax; VATS.
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