Traumatic haemothorax--experience of a protocol for rapid turnover in 1,845 cases

Incomplete or prolonged drainage of the pleural cavity for haemothorax may lead to the development of empyema, with long-term morbidity. Using a protocol based on vigorous physiotherapy and early withdrawal of the thoracostomy tube (average drainage time 27.1 hours), hospital stay in 1,845 patients with traumatic haemothorax was 48 hours or less in 81.8% of patients. In all, 152 haemothorax patients (8.1%) required either early or late thoracotomy, 46 of which were for associated cardiac injury. Prophylactic antibiotics were not given routinely. Severe complications occurred in 40 patients (2.2%); 15 developed empyema (0.8%) and 25 died (1.4%), mainly from ongoing haemorrhage. The early identification of patients needing operative or other intervention minimises the hospital stay and complications associated with residual blood in the pleural cavity. This study shows that the short-period drainage protocol used gives very acceptable results in the treatment of traumatic haemothorax.