Predictors of retained hemothorax in trauma: Results of an Eastern Association for the Surgery of Trauma multi-institutional trial

Priya S. Prakash; Sarah A. Moore; Joao B. Rezende-Neto; Sandy Trpcic; Julie A. Dunn; Brittany Smoot; Donald H. Jenkins; Tatiana Cardenas; Kaushik Mukherjee; Joshua Farnsworth; Jeffrey Wild; Katelyn Young; Thomas J. Schroeppel; Raul Coimbra; Jeanne Lee; David J. Skarupa; Michel J. Sabra; Matthew M. Carrick; Forrest O. Moore; Jeanette Ward; Thomas Geng; David Lapham; Alice Piccinini; Kenji Inaba; Christopher Dodgion; Brian Gooley; Tim Schwartz; Sarrina Shraga; James M. Haan; Kelly Lightwine; Jennifer Burris; Vaidehi Agrawal; Mark J. Seamon; Jeremy W. Cannon

doi:10.1097/TA.0000000000002881

Predictors of retained hemothorax in trauma: Results of an Eastern Association for the Surgery of Trauma multi-institutional trial

Priya S. Prakash^*, Sarah A. Moore, Joao B. Rezende-Neto, Sandy Trpcic, Julie A. Dunn, Brittany Smoot, Donald H. Jenkins, Tatiana Cardenas, Kaushik Mukherjee, Joshua Farnsworth, Jeffrey Wild, Katelyn Young, Thomas J. Schroeppel, Raul Coimbra, Jeanne Lee, David J. Skarupa, Michel J. Sabra, Matthew M. Carrick, Forrest O. Moore, Jeanette WardThomas Geng, David Lapham, Alice Piccinini, Kenji Inaba, Christopher Dodgion, Brian Gooley, Tim Schwartz, Sarrina Shraga, James M. Haan, Kelly Lightwine, Jennifer Burris, Vaidehi Agrawal, Mark J. Seamon, Jeremy W. Cannon

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

26 Scopus citations

Abstract

BACKGROUND The natural history of traumatic hemothorax (HTX) remains unclear. We aimed to describe outcomes of HTX following tube thoracostomy drainage and to delineate factors that predict progression to a retained hemothorax (RH). We hypothesized that initial large-volume HTX predicts the development of an RH. METHODS We conducted a prospective, observational, multi-institutional study of adult trauma patients diagnosed with an HTX identified on computed tomography (CT) scan with volumes calculated at time of diagnosis. All patients were managed with tube thoracostomy drainage within 24 hours of presentation. Retained hemothorax was defined as blood-density fluid identified on follow-up CT scan or need for additional intervention after initial tube thoracostomy placement for HTX. RESULTS A total of 369 patients who presented with an HTX initially managed with tube thoracostomy drainage were enrolled from 17 trauma centers. Retained hemothorax was identified in 106 patients (28.7%). Patients with RH had a larger median (interquartile range) HTX volume on initial CT compared with no RH (191 [48-431] mL vs. 88 [35-245] mL, p = 0.013) and were more likely to be older with a higher burden of thoracic injury. After controlling for significant differences between groups, RH was independently associated with a larger HTX on presentation, with a 15% increase in risk of RH for each additional 100 mL of HTX on initial CT imaging (odds ratio, 1.15; 95% confidence interval, 1.08-1.21; p < 0.001). Patients with an RH also had higher rates of pneumonia and longer hospital length of stay than those with successful initial management. Retained hemothorax was also associated with worse functional outcomes at discharge and first outpatient follow-up. CONCLUSION Larger initial HTX volumes are independently associated with RH, and unsuccessful initial management with tube thoracostomy is associated with worse patient outcomes. Future studies should use this experience to assess a range of options for reducing the risk of unsuccessful initial management. LEVEL OF EVIDENCE Therapeutic/care management study, level III.

Original language	English
Pages (from-to)	679-685
Number of pages	7
Journal	Journal of Trauma and Acute Care Surgery
Volume	89
Issue number	4
DOIs	https://doi.org/10.1097/TA.0000000000002881
State	Published - 1 Oct 2020
Externally published	Yes

Keywords

Hemothorax
empyema
trauma
tube thoracostomy

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10.1097/TA.0000000000002881

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Prakash, P. S., Moore, S. A., Rezende-Neto, J. B., Trpcic, S., Dunn, J. A., Smoot, B., Jenkins, D. H., Cardenas, T., Mukherjee, K., Farnsworth, J., Wild, J., Young, K., Schroeppel, T. J., Coimbra, R., Lee, J., Skarupa, D. J., Sabra, M. J., Carrick, M. M., Moore, F. O., ... Cannon, J. W. (2020). Predictors of retained hemothorax in trauma: Results of an Eastern Association for the Surgery of Trauma multi-institutional trial. Journal of Trauma and Acute Care Surgery, 89(4), 679-685. https://doi.org/10.1097/TA.0000000000002881

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title = "Predictors of retained hemothorax in trauma: Results of an Eastern Association for the Surgery of Trauma multi-institutional trial",

abstract = "BACKGROUND The natural history of traumatic hemothorax (HTX) remains unclear. We aimed to describe outcomes of HTX following tube thoracostomy drainage and to delineate factors that predict progression to a retained hemothorax (RH). We hypothesized that initial large-volume HTX predicts the development of an RH. METHODS We conducted a prospective, observational, multi-institutional study of adult trauma patients diagnosed with an HTX identified on computed tomography (CT) scan with volumes calculated at time of diagnosis. All patients were managed with tube thoracostomy drainage within 24 hours of presentation. Retained hemothorax was defined as blood-density fluid identified on follow-up CT scan or need for additional intervention after initial tube thoracostomy placement for HTX. RESULTS A total of 369 patients who presented with an HTX initially managed with tube thoracostomy drainage were enrolled from 17 trauma centers. Retained hemothorax was identified in 106 patients (28.7%). Patients with RH had a larger median (interquartile range) HTX volume on initial CT compared with no RH (191 [48-431] mL vs. 88 [35-245] mL, p = 0.013) and were more likely to be older with a higher burden of thoracic injury. After controlling for significant differences between groups, RH was independently associated with a larger HTX on presentation, with a 15% increase in risk of RH for each additional 100 mL of HTX on initial CT imaging (odds ratio, 1.15; 95% confidence interval, 1.08-1.21; p < 0.001). Patients with an RH also had higher rates of pneumonia and longer hospital length of stay than those with successful initial management. Retained hemothorax was also associated with worse functional outcomes at discharge and first outpatient follow-up. CONCLUSION Larger initial HTX volumes are independently associated with RH, and unsuccessful initial management with tube thoracostomy is associated with worse patient outcomes. Future studies should use this experience to assess a range of options for reducing the risk of unsuccessful initial management. LEVEL OF EVIDENCE Therapeutic/care management study, level III.",

keywords = "Hemothorax, empyema, trauma, tube thoracostomy",

author = "Prakash, {Priya S.} and Moore, {Sarah A.} and Rezende-Neto, {Joao B.} and Sandy Trpcic and Dunn, {Julie A.} and Brittany Smoot and Jenkins, {Donald H.} and Tatiana Cardenas and Kaushik Mukherjee and Joshua Farnsworth and Jeffrey Wild and Katelyn Young and Schroeppel, {Thomas J.} and Raul Coimbra and Jeanne Lee and Skarupa, {David J.} and Sabra, {Michel J.} and Carrick, {Matthew M.} and Moore, {Forrest O.} and Jeanette Ward and Thomas Geng and David Lapham and Alice Piccinini and Kenji Inaba and Christopher Dodgion and Brian Gooley and Tim Schwartz and Sarrina Shraga and Haan, {James M.} and Kelly Lightwine and Jennifer Burris and Vaidehi Agrawal and Seamon, {Mark J.} and Cannon, {Jeremy W.}",

year = "2020",

month = oct,

day = "1",

doi = "10.1097/TA.0000000000002881",

language = "English",

volume = "89",

pages = "679--685",

journal = "Journal of Trauma and Acute Care Surgery",

issn = "2163-0755",

publisher = "LWW",

number = "4",

}

Prakash, PS, Moore, SA, Rezende-Neto, JB, Trpcic, S, Dunn, JA, Smoot, B, Jenkins, DH, Cardenas, T, Mukherjee, K, Farnsworth, J, Wild, J, Young, K, Schroeppel, TJ, Coimbra, R, Lee, J, Skarupa, DJ, Sabra, MJ, Carrick, MM, Moore, FO, Ward, J, Geng, T, Lapham, D, Piccinini, A, Inaba, K, Dodgion, C, Gooley, B, Schwartz, T, Shraga, S, Haan, JM, Lightwine, K, Burris, J, Agrawal, V, Seamon, MJ & Cannon, JW 2020, 'Predictors of retained hemothorax in trauma: Results of an Eastern Association for the Surgery of Trauma multi-institutional trial', Journal of Trauma and Acute Care Surgery, vol. 89, no. 4, pp. 679-685. https://doi.org/10.1097/TA.0000000000002881

TY - JOUR

T1 - Predictors of retained hemothorax in trauma

T2 - Results of an Eastern Association for the Surgery of Trauma multi-institutional trial

AU - Prakash, Priya S.

AU - Moore, Sarah A.

AU - Rezende-Neto, Joao B.

AU - Trpcic, Sandy

AU - Dunn, Julie A.

AU - Smoot, Brittany

AU - Jenkins, Donald H.

AU - Cardenas, Tatiana

AU - Mukherjee, Kaushik

AU - Farnsworth, Joshua

AU - Wild, Jeffrey

AU - Young, Katelyn

AU - Schroeppel, Thomas J.

AU - Coimbra, Raul

AU - Lee, Jeanne

AU - Skarupa, David J.

AU - Sabra, Michel J.

AU - Carrick, Matthew M.

AU - Moore, Forrest O.

AU - Ward, Jeanette

AU - Geng, Thomas

AU - Lapham, David

AU - Piccinini, Alice

AU - Inaba, Kenji

AU - Dodgion, Christopher

AU - Gooley, Brian

AU - Schwartz, Tim

AU - Shraga, Sarrina

AU - Haan, James M.

AU - Lightwine, Kelly

AU - Burris, Jennifer

AU - Agrawal, Vaidehi

AU - Seamon, Mark J.

AU - Cannon, Jeremy W.

PY - 2020/10/1

Y1 - 2020/10/1

N2 - BACKGROUND The natural history of traumatic hemothorax (HTX) remains unclear. We aimed to describe outcomes of HTX following tube thoracostomy drainage and to delineate factors that predict progression to a retained hemothorax (RH). We hypothesized that initial large-volume HTX predicts the development of an RH. METHODS We conducted a prospective, observational, multi-institutional study of adult trauma patients diagnosed with an HTX identified on computed tomography (CT) scan with volumes calculated at time of diagnosis. All patients were managed with tube thoracostomy drainage within 24 hours of presentation. Retained hemothorax was defined as blood-density fluid identified on follow-up CT scan or need for additional intervention after initial tube thoracostomy placement for HTX. RESULTS A total of 369 patients who presented with an HTX initially managed with tube thoracostomy drainage were enrolled from 17 trauma centers. Retained hemothorax was identified in 106 patients (28.7%). Patients with RH had a larger median (interquartile range) HTX volume on initial CT compared with no RH (191 [48-431] mL vs. 88 [35-245] mL, p = 0.013) and were more likely to be older with a higher burden of thoracic injury. After controlling for significant differences between groups, RH was independently associated with a larger HTX on presentation, with a 15% increase in risk of RH for each additional 100 mL of HTX on initial CT imaging (odds ratio, 1.15; 95% confidence interval, 1.08-1.21; p < 0.001). Patients with an RH also had higher rates of pneumonia and longer hospital length of stay than those with successful initial management. Retained hemothorax was also associated with worse functional outcomes at discharge and first outpatient follow-up. CONCLUSION Larger initial HTX volumes are independently associated with RH, and unsuccessful initial management with tube thoracostomy is associated with worse patient outcomes. Future studies should use this experience to assess a range of options for reducing the risk of unsuccessful initial management. LEVEL OF EVIDENCE Therapeutic/care management study, level III.

AB - BACKGROUND The natural history of traumatic hemothorax (HTX) remains unclear. We aimed to describe outcomes of HTX following tube thoracostomy drainage and to delineate factors that predict progression to a retained hemothorax (RH). We hypothesized that initial large-volume HTX predicts the development of an RH. METHODS We conducted a prospective, observational, multi-institutional study of adult trauma patients diagnosed with an HTX identified on computed tomography (CT) scan with volumes calculated at time of diagnosis. All patients were managed with tube thoracostomy drainage within 24 hours of presentation. Retained hemothorax was defined as blood-density fluid identified on follow-up CT scan or need for additional intervention after initial tube thoracostomy placement for HTX. RESULTS A total of 369 patients who presented with an HTX initially managed with tube thoracostomy drainage were enrolled from 17 trauma centers. Retained hemothorax was identified in 106 patients (28.7%). Patients with RH had a larger median (interquartile range) HTX volume on initial CT compared with no RH (191 [48-431] mL vs. 88 [35-245] mL, p = 0.013) and were more likely to be older with a higher burden of thoracic injury. After controlling for significant differences between groups, RH was independently associated with a larger HTX on presentation, with a 15% increase in risk of RH for each additional 100 mL of HTX on initial CT imaging (odds ratio, 1.15; 95% confidence interval, 1.08-1.21; p < 0.001). Patients with an RH also had higher rates of pneumonia and longer hospital length of stay than those with successful initial management. Retained hemothorax was also associated with worse functional outcomes at discharge and first outpatient follow-up. CONCLUSION Larger initial HTX volumes are independently associated with RH, and unsuccessful initial management with tube thoracostomy is associated with worse patient outcomes. Future studies should use this experience to assess a range of options for reducing the risk of unsuccessful initial management. LEVEL OF EVIDENCE Therapeutic/care management study, level III.

KW - Hemothorax

KW - empyema

KW - trauma

KW - tube thoracostomy

UR - http://www.scopus.com/inward/record.url?scp=85092680516&partnerID=8YFLogxK

U2 - 10.1097/TA.0000000000002881

DO - 10.1097/TA.0000000000002881

M3 - Article

C2 - 32649619

AN - SCOPUS:85092680516

SN - 2163-0755

VL - 89

SP - 679

EP - 685

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

IS - 4

ER -

Predictors of retained hemothorax in trauma: Results of an Eastern Association for the Surgery of Trauma multi-institutional trial

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Keywords

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