title: The Epidemiology of Traumatic Hemothorax in a Level I Trauma Center: Case for Early Video-assisted Thoracoscopic Surgery.
abstract: OBJECTIVE
  Hemothorax is a common sequela of chest trauma. Complications after chest trauma include retained hemothorax and empyema requiring multiple interventions. We studied the epidemiology of hemothorax and its complications at a level I trauma center.
  
  
  METHODS
  The trauma registry was reviewed from Jan 1995 toMay 2005.Allpatients ≥16 years of agewhowere admitted with hemothorax, an AIS chest score of ≥ 3, and did not receive an immediate thoracotomy were entered in the study cohort. The patient demographics, details of the injury event, treatments, hospital length of stay (LOS), complications and outcome were analyzed.
  
  
  RESULTS
  The study cohort of 522 patients with a hemothorax were treated with 685 chest thoracostomy tubes. Overall, the median ISS was 18 and 62% were penetrating injuries. 109 patients (21%) had a retained hemothorax and required placement of ≥ 2 chest tubes with a median LOS of 15 days longer than patients with no retained hemothorax (p < 0.0001). The overall complication rate was 5% (26/522). Of these, 20 patients had empyema (3.8%), 8 patients required decortication, and 6 patients received streptokinase treatment.
  
  
  CONCLUSIONS
  More than 1 out of every 5 patients undergoing intervention for trauma-induced hemothorax develops a complication. The development of retained hemothorax is associated with empyema in 15.6% of cases and a 2-week median increase in length of stay. Future research into interventions such as Video-assisted thoracoscopic surgery (VATS) on the day of admission to completely evacuate hemothorax is warranted to reduce complication rates, length of stay and cost.
authors.affiliation: Division of Trauma and Critical Care, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA. jmacleo@emory.edu.|Division of Trauma and Critical Care, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA. jmacleo@emory.edu.
authors.forename: Jana B
authors.initials: JB
authors.lastname: MacLeod
authors.affiliation: Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Harvard Medical School, MassachusettsGeneral Hospital, Boston, MA, USA.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Ustin
authors.affiliation: Indiana University, School of Medicine, Indianapolis, IN, USA.
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Kim
authors.affiliation: Grady Health System, Grady Memorial Hospital, Altanta, GA, USA.
authors.forename: Fran
authors.initials: F
authors.lastname: Lewis
authors.affiliation: Division of Trauma and Critical Care, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Grace S
authors.initials: GS
authors.lastname: Rozycki
authors.affiliation: Division of Trauma and Critical Care, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: David V
authors.initials: DV
authors.lastname: Feliciano
keywords: Chest trauma; Epidemiology; Patient outcomes; Thoracic trauma
references.citation: J Trauma. 2007 May;62(5):1175-8; discussion 1178-9
references.pmid: 17495721
references.citation: Am J Respir Crit Care Med. 1998 Jan;157(1):328-30
references.pmid: 9445316
references.citation: Curr Opin Pulm Med. 1998 Jul;4(4):243-6
references.pmid: 10813242
references.citation: Acta Biomed. 2004 Dec;75(3):158-63
references.pmid: 15796089
references.citation: Arch Surg. 1995 May;130(5):521-5; discussion 525-6
references.pmid: 7748091
references.citation: Am J Surg. 1980 Dec;140(6):738-41
references.pmid: 7457693
references.citation: Am J Surg. 1984 Dec;148(6):786-90
references.pmid: 6507752
references.citation: J Trauma. 1984 Sep;24(9):785-9
references.pmid: 6481828
references.citation: J Trauma. 1989 Oct;29(10):1367-70
references.pmid: 2810412
references.citation: Am Surg. 2001 Dec;67(12 ):1165-9
references.pmid: 11768822
references.citation: Ann Thorac Surg. 1997 Apr;63(4):940-3
references.pmid: 9124967
references.citation: J Trauma. 2004 Dec;57(6):1178-83
references.pmid: 15625447
references.citation: J Trauma. 2006 Jan;60(1):111-4
references.pmid: 16456444
references.citation: J Trauma. 1993 Jan;34(1):144-7
references.pmid: 8437182
references.citation: J Trauma. 1999 Jan;46(1):65-70
references.pmid: 9932685
references.citation: Am J Surg. 1989 May;157(5):494-7
references.pmid: 2712206
references.citation: Ann Thorac Surg. 2004 Jul;78(1):282-5; discussion 285-6
references.pmid: 15223444
references.citation: Ann Thorac Surg. 1997 Nov;64(5):1396-400; discussion 1400-1
references.pmid: 9386710