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Is observation for traumatic hemothorax safe?

Leah Demetri1, Myriam M Martinez Aguilar, Jordan D Bohnen

  • 1From the Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery (L.D., M.M.M.A., J.D.B., D.D.Y., D.K., M.d.M.), and Department of Radiology(R.W.), Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts.

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Summary
This summary is machine-generated.

Selective observation of traumatic hemothorax is safe for select patients and may lead to better outcomes. Predictors of failed observation, such as older age and large hemothorax size, aid clinical decision-making for tube thoracostomy.

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Area of Science:

  • Trauma Surgery
  • Thoracic Surgery
  • Emergency Medicine

Background:

  • Eastern Association for the Surgery of Trauma guidelines recommend tube thoracostomy (TT) for all traumatic hemothoraces.
  • Previous research suggests some traumatic hemothoraces may be safely observed.
  • This study aimed to evaluate the safety of selective observation and identify predictors of failed observation.

Purpose of the Study:

  • To determine the safety of selective observation for traumatic hemothorax.
  • To identify predictors of failed observation in patients with traumatic hemothorax.
  • To inform clinical decision-making regarding the necessity of tube thoracostomy.

Main Methods:

  • Retrospective review of 340 patients with traumatic hemothorax at a Level I trauma center (2000-2014).
  • Hemothoraces categorized as small (<300 cc) or large (≥300 cc) by CT scan.
  • Patients grouped into early TT, failed observation, successful observation, or inevaluable due to early mortality.

Main Results:

  • 184 patients were initially observed; 66% were successfully observed, 29% failed observation, and 5% were inevaluable.
  • Predictors of failed observation included older age, fewer ventilation-free days, large hemothorax, and concurrent pneumothorax.
  • Successfully observed hemothoraces were predominantly small (98%).

Conclusions:

  • Initial observation is safe for select patients with traumatic hemothorax and may improve outcomes.
  • Identifying predictors of failed observation can guide the decision for tube thoracostomy.
  • Selective observation may reduce complications and improve patient disposition compared to early intervention.