POSTTRAUMATIC EMPYEMA - RISK FACTOR-ANALYSIS

Background: Empyema remains a distressing complication after thoracic injury. Objective: To identify high-risk factors associated with the d evelopment of empyema. Design: Retrospective cohort review. Setting: U niversity hospital, level I trauma center. Patients: Trauma patients w ho required tube thoracostomy (TT) between January 1, 1991, and Novemb er 31, 1993 (n=584). Methods: Data (demographic characteristics, injur ies, chest x-ray film reports, and setting of TT) were assessed using a stepwise logistic regression analysis to identify risk factors assoc iated with the development of post-traumatic empyema. Results: Empyema that required decortication developed in 25 patients (4%). Factors pr edictive of development of empyema were retained hemothorax (odds rati o, 12.5; 95% confidence interval, 0.96-163), pulmonary contusion (odds ratio, 6.3; 95% confidence interval, 1.53-25.8), and multiple chest t ube placement (odds ratio, 2.5; 95% confidence interval, 1.91-3.28); f actors not predictive of empyema were severity of injury, mechanism of injury, setting in which TT was performed, number of days chest tubes were in place, and antibiotic drugs at the time of TT. Conclusions: T he extent of pulmonary injury (pulmonary contusion) is an important pr edictor of empyema development. Previously implicated factors such as setting in which a TT was performed and mechanism of injury did not co rrelate with the development of posttraumatic empyema. Based on the re sults of our study, we recommend early drainage of the pleural space w ith video-assisted thoracoscopic techniques in patients at risk of emp yema, which may spare them the morbidity of a thoracotomy.