Early Management of Retained Hemothorax in Blunt Head and Chest Trauma

Fong‐Dee Huang,Yuan‐Yuarn Liu,Yi‐Pin Chou,Sheng‐Shih Chen,Wen‐Bin Yeh,I‐Yin Lu,Tzu‐Chin Wu

doi:10.1007/s00268-017-4420-x

Abstract

BackgroundMajor blunt chest injury usually leads to the development of retained hemothorax and pneumothorax, and needs further intervention. However, since blunt chest injury may be combined with blunt head injury that typically requires patient observation for 3–4 days, other critical surgical interventions may be delayed. The purpose of this study is to analyze the outcomes of head injury patients who received early, versus delayed thoracic surgeries.Materials and methodsFrom May 2005 to February 2012, 61 patients with major blunt injuries to the chest and head were prospectively enrolled. These patients had an intracranial hemorrhage without indications of craniotomy. All the patients received video-assisted thoracoscopic surgery (VATS) due to retained hemothorax or pneumothorax. Patients were divided into two groups according to the time from trauma to operation, this being within 4 days for Group 1 and more than 4 days for Group 2. The clinical outcomes included hospital length of stay (LOS), intensive care unit (ICU) LOS, infection rates, and the time period of ventilator use and chest tube intubation.ResultAll demographics, including age, gender, and trauma severity between the two groups showed no statistical differences. The average time from trauma to operation was 5.8 days. The ventilator usage period, the hospital and ICU length of stay were longer in Group 2 (6.77 vs. 18.55, p = 0.016; 20.63 vs. 35.13, p = 0.003; 8.97 vs. 17.65, p = 0.035). The rates of positive microbial cultures in pleural effusion collected during VATS were higher in Group 2 (6.7 vs. 29.0%, p = 0.043). The Glasgow Coma Scale score for all patients improved when patients were discharged (11.74 vs. 14.10, p < 0.05).DiscussionIn this study, early VATS could be performed safely in brain hemorrhage patients without indication of surgical decompression. The clinical outcomes were much better in patients receiving early intervention within 4 days after trauma.

Highlights

Materials and methodsIn Taiwan, blunt injury is the main type of trauma resulting from traffic accidents
Background Major blunt chest injury usually leads to the development of retained hemothorax and pneumothorax, and needs further intervention
Since blunt chest injury may be combined with blunt head injury that typically requires patient observation for 3–4 days, other critical surgical interventions may be delayed

Summary

Introduction

Materials and methodsIn Taiwan, blunt injury is the main type of trauma resulting from traffic accidents. Early VATS that could improve clinical outcomes has been proofed in many studies, timing of these operations is usually influenced by associated injuries, especially the head injury. Major blunt chest injury usually leads to the development of retained hemothorax and pneumothorax, and needs further intervention. Since blunt chest injury may be combined with blunt head injury that typically requires patient observation for 3–4 days, other critical surgical interventions may be delayed. Materials and methods From May 2005 to February 2012, 61 patients with major blunt injuries to the chest and head were prospectively enrolled. These patients had an intracranial hemorrhage without indications of craniotomy. The clinical outcomes were much better in patients receiving early intervention within 4 days after trauma

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