N. B. Lyons1, M. Mohamed1, B. L. Collie1, C. F. O’Neil1, W. A. Ramsey1, K. G. Proctor1, N. Namias1, J. P. Meizoso1 1University of Miami Miller School of Medicine, DeWitt Daughtry Family Department Of Surgery, Miami, FLORIDA, USA
Introduction: Traumatic hemothorax (HTX) is common and guidelines recommend HTX be drained with a tube thoracostomy, however the size that should be used has recently been challenged. We hypothesized that small-bore tube thoracostomies (≤14 Fr) are as effective as large-bore (≥20 Fr) for treatment of traumatic HTX.
Methods: Pubmed, EMBASE, and Scopus were searched to find studies that included adult patients with traumatic HTX that received a tube thoracostomy. The primary outcome was failure rate, defined as incompletely drained or retained HTX requiring a second intervention. Secondary outcomes included mortality, complications, initial drainage, and tube days. Cumulative analysis was performed with Fisher’s exact test for dichotomous variables and an unpaired t-test for continuous variables.
Results: 2,008 articles were screened of which nine were included in the analysis. There were two randomized controlled trials, two prospective, and five retrospective cohort studies. The studies included 1,847 patients (714 small-bore tubes and 1,233 large-bore tubes). The mean age of patients 46 years, 75% were male, average ISS was 20, and 81% had blunt trauma. Failure rate was not significantly different between small-bore (18.3%) and large-bore (21.7%) tubes (p=0.239). Additionally, there were no significant differences between small-bore vs. large-bore tubes in mortality (2.9% vs. 6.1%, p=0.072) or complication rate (18.0% vs. 14.9%, p=0.165), however small-bore tubes had significantly higher initial drainage volumes (753 vs 398 mL, p<0.001) and fewer tube days (4.3 vs. 6.2, p<0.001).
Conclusion: Small-bore thoracostomy may be as effective as large-bore thoracostomy for the treatment of traumatic HTX, as evidenced by similar rates of failure, complications, and mortality, although small-bore tubes may provide better drainage and resultant fewer days of total drainage.