title: Complications following thoracic trauma managed with tube thoracostomy.
abstract: BACKGROUND
  Tube thoracostomy is a common procedure used to treat traumatic chest injuries. Although the mechanism of injury traditionally does not alter chest tube management, complication rates may vary depending on the severity of injury. The purpose of this study was to investigate the incidence of and risk factors associated with chest tube complications (CTCs) following thoracic trauma.
  
  
  METHODS
  A retrospective chart review of all trauma patients (≥16 years old) admitted to an urban level 1 trauma centre (1/2007-12/2007) was conducted. Patients who required chest tube (CT) therapy for thoracic injuries within 24 h of admission and survived until CT removal were included. CTCs were defined as a recurrent pneumothorax or residual haemothorax requiring CT reinsertion within 24 h after initial tube removal or addition of new CT >24 h after initial placement. Variables including demographic data, mechanism, associated injuries, initial vital signs, chest abbreviated injury score (AIS), injury severity score (ISS), Glasgow coma score (GCS) and length of stay (LOS) and CT-specific variables (e.g. indication, timing of insertion, and duration of therapy) were compared using the chi square test, Mann-Whitney test, and multivariate analysis.
  
  
  RESULTS
  154 patients were included with 22.1% (n=34) developing a CTC. On univariate analysis, CTCs were associated with longer ICU and hospital LOS (p=0.02 and p<0.001), increased chest AIS (p=0.01), and the presence of an extrathoracic injury (p=0.047). Results of the multivariate analysis indicated that only increased chest AIS (OR 2.49; p=0.03) was a significantly independent predictor of CTCs.
  
  
  CONCLUSIONS
  CTCs following chest trauma are common and are associated with increased morbidity. The severity of the thoracic injury, as measured by chest AIS, should be incorporated into the development of CT management guidelines in order to decrease the incidence of CTCs.
authors.affiliation: Hospital of the University of Pennsylvania, Division of Traumatology, Surgical Critical Care, and Emergency Surgery, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Menger
authors.forename: Georgianna
authors.initials: G
authors.lastname: Telford
authors.forename: Patrick
authors.initials: P
authors.lastname: Kim
authors.forename: Meredith R
authors.initials: MR
authors.lastname: Bergey
authors.forename: Juron
authors.initials: J
authors.lastname: Foreman
authors.forename: Babak
authors.initials: B
authors.lastname: Sarani
authors.forename: Jose
authors.initials: J
authors.lastname: Pascual
authors.forename: Patrick
authors.initials: P
authors.lastname: Reilly
authors.forename: Charles W
authors.initials: CW
authors.lastname: Schwab
authors.forename: Carrie A
authors.initials: CA
authors.lastname: Sims
mesh_terms: D000328:Adult; D015505:Chest Tubes / Q000009:adverse effects*; D005260:Female; D006491:Hemothorax / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006801:Humans; D015994:Incidence; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D011030:Pneumothorax / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D011859:Radiography; D012189:Retrospective Studies; D013898:Thoracic Injuries / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D013907:Thoracostomy / Q000009:adverse effects* / Q000379:methods; D055815:Young Adult