Predictors of retained hemothorax after trauma and impact on patient outcomes.

Abstract

Hemo/pneumothoraces are a common result of thoracic injury. Some of these injuries will be complicated by retained hemothorax (RH), which has previously been shown to be associated with longer hospitalizations. It has been proposed that early versus delayed intervention with video-assisted thoracoscopic surgery can reduce the duration of mechanical ventilation, hospital and ICU LOS, and costs in patients with RH. However, little is known regarding the effect of RH on these outcomes relative to patients with uncomplicated hemo/pneumothoraces. The aim of our study was to characterize factors present on admission that may be associated with RH and assess the impact of RH on outcomes. A retrospective chart review was conducted and included all patients who underwent tube thoracostomy (TT) for traumatic hemo/pneumothorax admitted to a single urban adult and pediatric level I trauma center from January 2008 to September 2013. The study cohort included 398 patients, 17.6% developed RH. RH was associated with significantly longer total duration of TT drainage (p<0.001), hospital LOS (p<0.001), and total hospital charges (p<0.001). These associations remained significant in a subgroup analysis excluding patients with traumatic brain injury. Patients with bilateral injuries (OR 4.25, p<0.001) and patients intubated on the day of admission (OR 2.30, p=0.002) were significantly more likely to develop RH. There was also a small, but highly significant, association between increasing ISS and the development of RH (OR 1.07, p<0.001). Our study suggests patients requiring ventilator support on admission and those with bilateral injuries are at increased risk of developing RH. Early identification of patients at risk for RH may allow for earlier intervention and potential benefits to the patient.