W. Butak1,2, P. Srivastava1, T. Carver2 1Medical College Of Wisconsin, Medical School, Milwaukee, WI, USA 2Medical College Of Wisconsin, Division Of Trauma And Acute Care, Milwaukee, WI, USA
Introduction: Traumatic hemothorax (HTX) is a common condition and almost all are successfully treated with thoracostomy tube (TT). Chest x-rays (CXR) are often used to determine adequacy of drainage after TT placement, but it is unclear if early imaging findings correlate with retained hemothorax. We hypothesized that post-TT placement CXR findings would correlate with the need for secondary intervention for retained hemothorax.
Methods: A secondary analysis from a prospective, observational study was performed on all patients enrolled in the Western Trauma Association Multi-Centers Trials Thoracic Irrigation Study. Patients were included if age ≥18 years and had TT placed for a hemothorax. Pre-TT, post-TT, day 1, day 2, and day 3 CXR interpretations were coded as either “improved” or “not improved” when available.
Results: 401 unique patients (428 hemothoraces) were included. Imaging improvements from pre- to post-TT placement were not correlated with need for secondary intervention (p =0.14); however, improvement on CXR from post-TT placement to day 1, as well as day 2 to day 3 post-TT placement is associated with less need for secondary intervention (p=0.02 and p=0.0002, respectively).?
Conclusion: Initial changes in CXR between pre- to post-TT placement do not correlate with the need for secondary intervention but day 1 and day 2 CXR improvement did. Many factors are considered when determining the need for reintervention for retained hemothorax, and these findings suggest that the immediate post-TT CXR should not be one of them.