title: VATS versus intrapleural streptokinase: A prospective, randomized, controlled clinical trial for optimum treatment of post-traumatic Residual Hemothorax.
abstract: BACKGROUND
  Post-traumatic residual haemothorax (RH) is common and carries significant morbidity. However, its optimal treatment is not clear.
  
  
  OBJECTIVE
  The aim of this study was to find the extent of this problem and the choice of treatment between VATS and intra-pleural streptokinase instillation (IPSI).
  
  
  METHODS
  This RCT, conducted over 18 months period, included all patients of chest trauma between 18 and 70 years of age, admitted with haemothorax or haemopneumothorax requiring inter-costal drain (ICD) insertion. 154 events of haemothorax/haemopneumothorax requiring ICD insertion were enrolled. RH was seen in 48 (31%) patients: 13 patients were excluded from RCT after refusal for treatment. Seventeen (49%) patients of remaining 35 RH cases were randomized to IPSI group and 18 (51%) patients were randomized to VATS group. The outcome parameters were resolution of RH and treatment related complications.
  
  
  RESULTS
  RH resolved equally well in VATS and IPSI group [13 patients (72%) versus 12 patients (71%), respectively; continuity-adjusted p=1]. Morbidity wise no difference (p-value 0.529) was seen in the two groups.
  
  
  CONCLUSIONS
  Post-traumatic RH is seen in 1/3rd patients and is equally well treated by VATS and IPSI.
authors: Department of General Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, New Delhi 95, India.
authors: S
authors: S
authors: Kumar
authors: Department of Radio-diagnosis, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, New Delhi 95, India.
authors: V
authors: V
authors: Rathi
authors: Department of Trauma Surgery, JPN Apex Trauma Center, AIIMS, New Delhi 29, India. Electronic address: amulyarattan@rediffmail.com.
authors: A
authors: A
authors: Rattan
authors: Department of Anethesiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, New Delhi 95, India.
authors: S
authors: S
authors: Chaudhary
authors: Department of General Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, New Delhi 95, India.
authors: N
authors: N
authors: Agarwal
mesh_terms: D000328:Adult; D015505:Chest Tubes; D004322:Drainage; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006491:Hemothorax / Q000188:drug therapy / Q000209:etiology / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007194:India / Q000453:epidemiology; D007902:Length of Stay; D008297:Male; D011446:Prospective Studies; D013300:Streptokinase / Q000008:administration & dosage*; D013898:Thoracic Injuries / Q000150:complications / Q000401:mortality / Q000628:therapy*; D020775:Thoracic Surgery, Video-Assisted; D015912:Thrombolytic Therapy; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000401:mortality / Q000628:therapy*
chemical_list: D005343:Fibrinolytic Agents; D013300:Streptokinase
keywords: Chest trauma; Haemothorax; Intercostal drainage; Intrapleural streptokinase; Residual haemothorax; Retained haemothorax; VATS