TUBE THORACOSTOMY - FACTORS RELATED TO COMPLICATIONS

Objective: To determine the complication rate and risk factors associa ted with tube thoracostomy (TT) in the trauma patient. Design: Retrosp ective hospital chart review. Setting: Level I trauma center. Patients : Four hundred twenty-six consecutive patients who underwent TT were i nitially reviewed; 47 deaths occurred unrelated to TT placement. The r emaining 379 patients required 599 tubes and composed the study popula tion. Main Outcome Measures: The determination of adverse outcomes rel ated to TT, including thoracic empyema, undrained hemothorax or pneumo thorax, improper tube positioning, post-tube removal complications, an d direct injuries to the lung.Results: The overall complication rate w as 21% per patient. Although complications were not related to the Inj ury Severity Score, the presence of shock, admission to the intensive care unit, and the need for mechanical ventilation were associated wit h the increased incidence of complications. There were fewer complicat ions (6%) when the TT was performed by a surgeon compared with TT perf ormed by an emergency physician (13%, P<.0001) or TT performed prior t o transfer to our hospital (38%, P<.0001). Conclusions: Tube thoracost omy is associated with significant morbidity. The striking difference in the complication rate between surgeons and other physicians who per form this procedure suggests that additional training may be indicated .