Can Concurrent Traumatic Hemopneumothorax be Safely Observed?

IF 1.8 3区 医学 Q2 SURGERY Journal of Surgical Research Pub Date : 2024-10-24 DOI:10.1016/j.jss.2024.09.085
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
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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.

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能否安全地观察并发创伤性血气胸?
导言:创伤性血气胸(HTX)和气胸(PTX)同时发生的情况极为常见(70%)。先前的研究表明,单独观察小的 HTX(≤300 立方厘米)和 PTX(≤35 毫米)是安全的。因此,我们试图评估同时观察小血气胸(HPTX)的安全性:我们在一家一级创伤中心开展了一项单中心回顾性研究(2015-2021 年)。经计算机断层扫描(CT)证实为 HPTX 的患者被纳入研究范围。排除标准包括 CT 扫描前进行管式胸腔造口术(TT)、为肋骨固定而置入 TT、PTX>35 毫米、HTX>300 立方厘米以及入院 72 小时内死亡。研究组被分为初始观察组和早期TT组,早期TT组的定义是在初始CT扫描后立即进行TT置管。主要结果为观察失败:共有 353 名患者符合纳入标准,其中 261 人(74%)接受了初始观察。与初次置入 TT 的患者相比,初次观察组的肺部发病率较低(9% 对 14%; P = 0.04),住院时间(7 天对 10 天,P < 0.001)和重症监护室住院时间(2 天对 4 天,P = 0.01)较短。68例(26%)患者未能通过观察,最常见的原因是重复造影显示 HTX 恶化(45%)。与接受早期 TT 的患者相比,观察失败者的肺部发病率、视频辅助胸腔镜手术需求、TT 持续时间、住院时间、再入院率和死亡率相似:并发小创伤性 HPTX 的初始观察肺部发病率和 LOS 均较低,但发现有临床意义的失败率。观察失败的患者与接受早期TT的患者结果相似。
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来源期刊
CiteScore
3.90
自引率
4.50%
发文量
627
审稿时长
138 days
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.
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