Brief report
Complication rates of tube thoracostomy

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Abstract

This study compared the complication rates of tube thoracostomy performed in the emergency department (ED) versus the operating room (OR) and the inpatient ward (IW). A retrospective case series of all patients at an urban, university-based level 1 trauma center hospital who received tube thoracostomy for any indication between 1/1/93 and 12/31/93 was conducted. Complications were defined as empyema, unresolved pneumothorax (persistent air leak or residual pneumothorax), persistent effusion, or incorrect placement. The data for age and duration of tube placement were weighted for analysis of variance (ANOVA). A total of 352 tube thoracostomies was placed in 239 patients. Twenty-three patients had three or more chest tubes placed, 65 had two placed, and the remaining 181 had a single tube. Ninety-nine tubes were placed in the ED, 87 in the OR, and 166 on IW. The mean age of patients in the ED was 37 years, and differed significantly (P < .015) from those in the OR (48 years) and the IW (44 years). The duration of tube placement was similar for all groups (mean = 6.5 days). The overall complication rates related to tube insertion were: ED, 14.0%; OR, 9.2%; IW, 25.3%. Significance was achieved when comparing complication rates between the ED and IW, with less complications in the ED (P = .436). When comparing complication rates between the ED and OR, there was no significant difference (P = .3643). A power calculation indicated too small of a sample size to truly determine an insignificant difference between complication rates between the ED and OR. Placement of emergent thoracostomy tubes in the Ed does not result in an increased complication rates as compared to placement in the IW.

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    Studies have shown that nonsurgical residents and insertion outside of the trauma bay were predictive of complications. Other studies have also demonstrated that complication rates of tube placement were lower in the operating room than the emergency room, and both the operating room and emergency room were significantly lower than in the inpatient wards.6 The purpose of this study was to evaluate complications of chest tube placement in a level 1 trauma center compared with those placed in surrounding referral hospitals, with a view to evaluating opportunities for improving the care of patients with thoracic trauma at a system level.

  • Emergency Medical Services Simple Thoracostomy for Traumatic Cardiac Arrest: Postimplementation Experience in a Ground-based Suburban/Rural Emergency Medical Services Agency

    2018, Journal of Emergency Medicine
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    What is clear is that both approaches have significant failure rates and issues related to misplacement and iatrogenic injury (13–24). Given the problematic nature of needle decompression, tube thoracostomy has clear advantages but has reported complication rates ranging from 3–30% (25–29). Given the austere environments of prehospital medicine and the complication rate of tube thoracostomy, simple or finger thoracostomy may represent the most rational approach to thoracostomy in the prehospital setting.

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Presented at SAEM Research Forum, May, 1995, San Antonio, TX.

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