Complications of tube thoracostomy using Advanced Trauma Life Support technique in chest trauma

Tube thoracostomy (TT) is central in the management of chest trauma sufficing in over 80% of cases. As a result the procedure is commonly performed in most emergency departments.

The aim of this study was to assess the efficacy and complications of TT using Advanced Trauma Life Support (ATLS) technique in chest trauma.

This prospective study was done at the Trauma Unit of the University of Benin Teaching Hospital in Nigeria. All patients with chest trauma who needed tube thoracostomy between February 2006 and February 2009 were studied. Data recorded for each patient included injury, mechanism of injury, Glasgow Coma score, revised trauma score, and indications for tube thoracostomy. Chest radiographs were obtained preinsertion, post insertion and post extubation for all the cases. Patients were monitored for tube thoracostomy complications.

Of 9415 trauma patients seen during the period 105 patients had tube thoracostomy but only 70 (56 male, 14 female) had adequate data for analysis. Seventy-four tubes were passed in the 70 patients with unilateral tubes in 66 (94.3%) and bilateral tubes in 4 (5.7%). Blunt chest trauma occurred in 32 (45.7%) and penetrating chest trauma in 38 (54.3%) of the patients. Simple haemothorax and haemopneumothorax were the commonest indications for tube thoracostomy. Complications recorded include four cases of kinked tubes, four of superficial wound infection and 10 cases of residual haemothorax.

Tube thoracostomy in the emergency department using advanced trauma life support principles is effective in chest trauma and associated with few complications.