Beyond the tube: Can we reduce chest tube complications in trauma patients?

Abstract

Background: We sought to identify opportunities for interventions to mitigate complications of tube thoracostomy (TT).

Methods: Retrospective review of all trauma patients undergoing TT from 6/30/2016-6/30/2019. Multivariable logistic regression identified independent predictors of complications.

Results: Out of 451 patients, 171 (37.9%) had at least one TT malpositioning or complication. Placement in the emergency department, placement by emergency medicine physicians, and body mass index >30 kg/m² were independent predictors of complication. Malpositioning increased the likelihood of early complication (6.5%-53.5%), and early complication increased the likelihood of late complication (4.3%-13.6%). Patients with a late complication had, on average, a 7.56 day longer hospital stay than patients without a late complication.

Conclusion: TT complications were associated with placement in the emergency department, placement by emergency medicine physicians, and BMI>30 kg/m². We identified associations between malpositioning, early complications, and late complications, and demonstrated that TT complications impact patient outcomes.

Keywords: Chest; Hemothorax; Pneumothorax; Thoracostomy; Tube.