Abdul Hafiz Al Tannir, Morgan Tentis, Morgan Maring, Bryce Patin, Elise A Biesboer, Simin Golestani, Courtney J Pokrzywa, Jacob Peschman, Patrick B Murphy, Rachel S Morris, Thomas W Carver, Marc A de Moya
{"title":"Can Concurrent Traumatic Hemopneumothorax be Safely Observed?","authors":"Abdul Hafiz Al Tannir, Morgan Tentis, Morgan Maring, Bryce Patin, Elise A Biesboer, Simin Golestani, Courtney J Pokrzywa, Jacob Peschman, Patrick B Murphy, Rachel S Morris, Thomas W Carver, Marc A de Moya","doi":"10.1016/j.jss.2024.09.085","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>The cooccurrence of a traumatic hemothorax (HTX) and pneumothorax (PTX) is extremely common (70%). Prior work shows the safety of observing small HTX (≤300 cubic centimeters) and PTX (≤35 mm) in isolation. Accordingly, we sought to assess the safety of observation of concurrent small hemopneumothorax(HPTX).</p><p><strong>Methods: </strong>We conducted a single-center retrospective study from 2015 to 2021 at a level I trauma center. Patients with a computed tomography (CT) scan confirmed that HPTXwas included in the study. Exclusion criteria included tube thoracostomy (TT) prior to CT scan, TT placement for rib fixation, PTX>35 mm, HTX>300 cubic centimeters, and death within 72 h of admission. The study group was stratified into either initial observation or early TT, which is defined as TT placement immediately after initial CT scan. Primary outcome was observation failure.</p><p><strong>Results: </strong>A total of 353 patients met the inclusion criteria, of whom 261 (74%) were initially observed. The initial observation cohort had a lower pulmonary morbidity rate (9% versus 14%; P = 0.04) and a shorter hospital (7 versus 10 d, P < 0.001) and intensive care unit (2 versus 4 d, P = 0.01) length of stay (LOS) when compared to those with initial TT placement. Sixty-eight (26%) patients failed observation, with a worsening HTXon repeat imaging (45%) being the most common reason. Compared to those who received an early TT, those who failed observation had a similar pulmonary morbidity and need for video-assisted thoracoscopic surgery, TT duration, LOS, readmission, and mortality rates.</p><p><strong>Conclusions: </strong>Initial observation of concurrent small traumatic HPTX had a lower pulmonary morbidity and LOS but was found to have a clinically significant failure rate. Patients who failed observation had similar outcomes to those who received an early TT.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":null,"pages":null},"PeriodicalIF":1.8000,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Surgical Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jss.2024.09.085","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: The cooccurrence of a traumatic hemothorax (HTX) and pneumothorax (PTX) is extremely common (70%). Prior work shows the safety of observing small HTX (≤300 cubic centimeters) and PTX (≤35 mm) in isolation. Accordingly, we sought to assess the safety of observation of concurrent small hemopneumothorax(HPTX).
Methods: We conducted a single-center retrospective study from 2015 to 2021 at a level I trauma center. Patients with a computed tomography (CT) scan confirmed that HPTXwas included in the study. Exclusion criteria included tube thoracostomy (TT) prior to CT scan, TT placement for rib fixation, PTX>35 mm, HTX>300 cubic centimeters, and death within 72 h of admission. The study group was stratified into either initial observation or early TT, which is defined as TT placement immediately after initial CT scan. Primary outcome was observation failure.
Results: A total of 353 patients met the inclusion criteria, of whom 261 (74%) were initially observed. The initial observation cohort had a lower pulmonary morbidity rate (9% versus 14%; P = 0.04) and a shorter hospital (7 versus 10 d, P < 0.001) and intensive care unit (2 versus 4 d, P = 0.01) length of stay (LOS) when compared to those with initial TT placement. Sixty-eight (26%) patients failed observation, with a worsening HTXon repeat imaging (45%) being the most common reason. Compared to those who received an early TT, those who failed observation had a similar pulmonary morbidity and need for video-assisted thoracoscopic surgery, TT duration, LOS, readmission, and mortality rates.
Conclusions: Initial observation of concurrent small traumatic HPTX had a lower pulmonary morbidity and LOS but was found to have a clinically significant failure rate. Patients who failed observation had similar outcomes to those who received an early TT.
期刊介绍:
The Journal of Surgical Research: Clinical and Laboratory Investigation publishes original articles concerned with clinical and laboratory investigations relevant to surgical practice and teaching. The journal emphasizes reports of clinical investigations or fundamental research bearing directly on surgical management that will be of general interest to a broad range of surgeons and surgical researchers. The articles presented need not have been the products of surgeons or of surgical laboratories.
The Journal of Surgical Research also features review articles and special articles relating to educational, research, or social issues of interest to the academic surgical community.