title: Thin chest wall is an independent risk factor for the development of pneumothorax after chest tube removal.
abstract: The factors contributing to the development of pneumothorax after removal of chest tube thoracostomy are not fully understood. We hypothesized that development of post pull pneumothorax (PPP) after chest tube removal would be significantly lower in those patients with thicker chest  walls, due to the "protective" layer of adipose tissue. All patients on our trauma service who underwent chest tube thoracostomy from July 2010 to February 2011 were retrospectively reviewed. Patient age, mechanism of trauma, and chest Abbreviated Injury Scale score were analyzed.  Thoracic CTs were reviewed to ascertain chest wall thickness (CW). Thickness was measured at the level of the nipple at the midaxillary line, as perpendicular distance between skin and pleural cavity. Chest X-ray reports from immediately prior and after chest tube removal were reviewed for  interval development of PPP. Data are presented as average ± standard deviation. Ninety-one chest tubes were inserted into 81 patients. Patients who died before chest tube removal (n = 11), or those without thoracic CT scans (n = 13) were excluded. PPP occurred in 29.9 per cent of chest  tube removals (20/67). When PPP was encountered, repeat chest tube was necessary in 20 per cent of cases (4/20). After univariate analysis, younger age, penetrating mechanism, and thin chest wall were found to be significant risk factors for development of PPP. Chest Abbreviated Injury Scale  score was similar in both groups. Logistic regression showed only chest wall thickness to be an independent risk factor for development of PPP.
authors.affiliation: Virginia Commonwealth University, Department of Surgery, Division of Trauma, Critical Care, and Emergency Surgery, Richmond, Virginia, USA. ranand@mcvh-vcu.edu
authors.forename: Rahul J
authors.initials: RJ
authors.lastname: Anand
authors.forename: James F
authors.initials: JF
authors.lastname: Whelan
authors.forename: Paula
authors.initials: P
authors.lastname: Ferrada
authors.forename: Therese M
authors.initials: TM
authors.lastname: Duane
authors.forename: Ajai K
authors.initials: AK
authors.lastname: Malhotra
authors.forename: Michel B
authors.initials: MB
authors.lastname: Aboutanos
authors.forename: Rao R
authors.initials: RR
authors.lastname: Ivatury
mesh_terms: D015998:Abbreviated Injury Scale; D000273:Adipose Tissue; D000328:Adult; D015505:Chest Tubes; D020878:Device Removal / Q000009:adverse effects*; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D011030:Pneumothorax / Q000209:etiology* / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D035441:Thoracic Wall / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000601:surgery; D013907:Thoracostomy; D014057:Tomography, X-Ray Computed