75.01 Predictive Factors in Trauma Patients with Hemothorax Requiring Video-Assisted Thoracoscopic Surgery

Posted on April 24, 2024

J. Nakata1, M. Clark1, R. Davis1, T. Witek1, O. Awais1, A. Corcos1, K. R. Stahlfeld1  1UPMC Mercy, Department Of Surgery, Pittsburgh, PA, USA

Introduction:
Post-traumatic hemothorax is a challenging problem often managed by pleural drainage, video-assisted thoracoscopy (VATS), or thoracotomy. The intent of this study was to identify predictive factors in patients with traumatic hemothorax that would require subsequent delayed VATS.

Methods:
A retrospective review was conducted of all trauma patients diagnosed with hemothorax from January 2016 to December 2020 at a Level 1 Trauma Center. Demographics, mechanism of injury, catheter type, catheter output, interventions, hospital and ICU length of stay were collected. Descriptive summary statistics and a multivariable logistic regression model were used to determine predictive factors in patients who underwent delayed VATS.

Results:

Hemothorax was identified in 347 patients. The average age was 54-years with 267 (77%) males. Mean injury severity score (ISS) was 29. Blunt trauma accounted for 245 (70.6%) patients. 341 (98.3%) patients required initial placement of a thoracostomy tube. 259 (76%) patients had a large-bore chest tube, and 82 (24%) had an 8.3Fr pigtail.

Average initial and 24-hour thoracostomy tube outputs were 341cc and 531cc, respectively. Both initial and 24-hour outputs were the strongest independent predictors of need for delayed VATS when controlling for age and ISS (p=0.0009 and p=0.05 respectively). Initial output <500cc was a negative predictor for requiring delayed VATS (p=0.01). Pigtail placement approached significance for requiring VATS, but was non-significant when adjusted for age, ISS, and output. Antibiotics prior to chest tube placement, ISS, and blood transfusions were not significantly correlated with need for delayed VATS.

 

Conclusion:
Hemothorax is frequently encountered in the trauma population. Management typically involves pleural drainage. Initial and 24-hour thoracostomy tube outputs were significant independent predictors for requiring subsequent delayed VATS.