Video-assisted thoracoscopy in the early diagnosis and management of post-traumatic pneumothorax and hemothorax.
BACKGROUND
Blunt and penetrating chest traumas continue to be associated with a high mortality rate. The related morbidity rate is a also cause for concern because it may result in extended hospitalization and permanent disabilities. The aim of this study was to retrospectively review a series of consecutive patients treated for chest trauma between 1 January 2000 and 31 December 2005, focusing particularly on cases of pneumothorax and hemothorax. alone or in combination, and to critically assess the treatment protocol adopted.


METHODS
Eighty-one patients with pneumothorax and/or hemothorax were subdivided into two groups. Group I (n = 46) comprised 36 patients with an Injury Severity Score (ISS) <9 and 10 patients with ISS from 9 to 15, all of whom were treated with chest tube alone. Group II (n = 35) included 34 patients with an ISS >9 who were treated with tube thoracostomy and VATS and 1 patient was treated by emergency thoracotomy.


RESULTS
The time to complete recovery was virtually identical in both groups.


CONCLUSIONS
In light of their own experience and of reports in the literature confirming both the diagnostic and therapeutic efficacies of VATS in chest trauma with pneumothorax and/or hemothorax, the authors propose a treatment protocol prescribing its use 48 h from the traumatic event in all cases of uncontrolled air and/or blood loss. This protocol yielded excellent results, including an uneventful postoperative course, rapid resolution of the signs and symptoms of the chest problem, and no disabling sequelae (empyema and fibrothorax), as well as a relatively shorter hospital stay and hence lower costs than with conservative treatment.
Fabbrucci
Paolo
P
Department of General Surgery, Santa Maria Annunziata Hospital, Via dell'Antella, 58, 50012, Florence, Italy. paolo.fabbrucci@asf.toscana.it
Nocentini
Luciano
L
Secci
Stefano
S
Manzoli
Daniela
D
Bruscino
Alessandro
A
Fedi
Massimo
M
Paroli
Gian Matteo
GM
Santoni
Simona
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015505:Chest Tubes; D002985:Clinical Protocols; D042241:Early Diagnosis; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006491:Hemothorax / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D013898:Thoracic Injuries / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome; D055815:Young Adult