Thoracotomy for blunt chest trauma: is chest tube output a useful criterion?

The aim of this study was to determine whether the traditional criteria of chest tube output are useful indicators for urgent thoracotomy in patients with blunt chest trauma.

Data were collected retrospectively from our trauma registry of 542 blunt chest trauma patients (Chest Abbreviated Injury Scale score of 3 or greater) over a 10-year period (2000-2010). The 1-h chest tube output was calculated from chest tube output and time after admission, and the results were compared between patients who underwent thoracotomy for hemorrhage and those who did not.

Data were available for 24 patients who underwent thoracotomy for hemorrhage and 93 patients who did not undergo thoracotomy. The 1-h chest tube output between the groups was significantly different (708.0 ± 258.3 mL versus 108.9 ± 222.9 mL). Receiver operating characteristic curve analysis of the predictive value of 1-h chest tube output for thoracotomy was conducted. The area under the receiver operating characteristic curve was 0.98, and the cutoff 1-h chest tube output value for predicting thoracotomy was 404 mL (sensitivity, 87.5%; specificity, 96.8%).

The 1-h chest tube output of patients who underwent thoracotomy was lower than the thresholds traditionally reported as indications for urgent thoracotomy. High chest tube output as a traditional indicator for thoracotomy may not apply to patients with blunt chest trauma.