title: Natural history of a postpull pneumothorax or effusion: observation is safe.
abstract: BACKGROUND
  Thoracostomy tube (TT) for drainage of hemopneumothorax is the most common intervention in thoracic trauma. Postpull pneumothorax or effusion (PPP/PPE) is common after removal of a TT. The natural history of PPP/PPE after discharge has not been described. This study evaluates the outcomes and management of PPP/PPE after discharge.
  
  
  METHODS
  Trauma patients with TT placed from July 1, 2008, to June 30, 2013, were identified from an administrative database and trauma registry. PPP/PPE was defined as the presence of air or fluid in the chest on a postpull imaging. The electronic medical record and final radiology interpretation were reviewed to confirm PPP/PPE during index admission and at discharge. Clinical follow-up and imaging were reviewed for the presence of persistent PPP/PPE. Interventions directed toward PPP/PPE and readmissions were recorded for patients with and without a PPP/PPE. Multivariate logistic regression was performed to identify factors for chest-related readmission.
  
  
  RESULTS
  Seven hundred ten patients surviving to discharge had a TT placed during the study time frame. Of the 151 patients (21.3%) with documented PPP/PPE on discharge, 115 patients had follow-up data available. Outpatient imaging was obtained in 35 patients, with persistent PPP/PPE noted in 16 patients (45.7%). Six patients (4%) with PPP/PPE at discharge required reintervention. Patients without documented PPP/PPE at discharge had a lower readmission rate (0.7% vs. 6.6%, p = 0.02). Multivariate logistic regression noted the presence of persistent PPP/PPE at follow-up (p = 0.001) to be associated with readmission.
  
  
  CONCLUSIONS
  PPP/PPE is a common occurrence following removal of a TT. While patients discharged with PPP/PPE have a statistically higher reintervention rate, the absolute value remains low. This should be considered when treating clinically stable, asymptomatic PPP/PPE.
  
  
  METHODS
  Epidemiologic study, level IV.
authors.affiliation: From the Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Nathan W
authors.initials: NW
authors.lastname: Kugler
authors.forename: David J
authors.initials: DJ
authors.lastname: Milia
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Carver
authors.forename: Kathleen
authors.initials: K
authors.lastname: O'Connell
authors.forename: Jasmeet
authors.initials: J
authors.lastname: Paul
mesh_terms: D000328:Adult; D015505:Chest Tubes; D020878:Device Removal; D003952:Diagnostic Imaging; D004322:Drainage; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000209:etiology*; D011030:Pneumothorax / Q000209:etiology*; D012042:Registries; D019233:Retreatment; D012307:Risk Factors; D013898:Thoracic Injuries / Q000628:therapy*; D013907:Thoracostomy; D014193:Trauma Centers; D016896:Treatment Outcome