title: Thoracostomy tube function not trajectory dictates reintervention.
abstract: Hemothorax and/or pneumothorax can be managed successfully managed with tube thoracostomy (TT) in the majority of cases. Improperly placed tubes are common with rates near 30%. This study aimed to determine whether TT trajectory affects the rate of secondary intervention.
  
  
  
  A retrospective review of all adult trauma patients undergoing TT placement over a 4-y period was performed. TT trajectory was classified as ideal, nonideal, or kinked-based on anterior-posterior chest x-ray. TTs with sentinel port outside the thoracic cavity were excluded. The primary outcome was any secondary intervention.
  
  
  
  Four-hundred eighty-six patients and a total of 547 hemithoraces underwent placement and met inclusion criteria. The majority of patients were male (76%), with a median age of 41 y, and majority suffered blunt trauma ideal trajectory was identified in 429 (78.4%). Kinked TTs were noted in 33 (6%) hemothoraces with a 45.5% replacement rate. Review with staff demonstrates inherent bias to replace kinked TTs. The overall secondary intervention rate was 27.8%. Kinked TTs were removed from final analysis due to treatment bias. Subsequent analysis demonstrated no significant difference between ideal and nonideal trajectories (25.1% versus 34.1%, P = 0.09).
  
  
  
  Intrathoracic trajectory of nonkinked TTs with the sentinel port within the thoracic cavity does not affect secondary intervention rates, including the rate of surgical intervention.
authors.affiliation: Division of Trauma and Critical Care, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin. Electronic address: nkugler@mcw.edu.
authors.forename: Nathan W
authors.initials: NW
authors.lastname: Kugler
authors.affiliation: Division of Trauma and Critical Care, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Carver
authors.affiliation: Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Paul
authors.initials: P
authors.lastname: Knechtges
authors.affiliation: Division of Trauma and Critical Care, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: David
authors.initials: D
authors.lastname: Milia
authors.affiliation: Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Goodman
authors.affiliation: Division of Trauma and Critical Care, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Jasmeet S
authors.initials: JS
authors.lastname: Paul
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015505:Chest Tubes; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006491:Hemothorax / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013907:Thoracostomy / Q000295:instrumentation*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Chest tube; Hemopneumothorax; Hemothorax; Pneumothorax; Thoracic trauma; Thoracostomy tube; Trauma