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Complication to consider: delayed traumatic hemothorax in older adults
Jeff Choi1, Ananya Anand1, Katherine D Sborov2
1Surgery, Stanford University, Stanford, California, USA.
Trauma Surgery & Acute Care Open
|March 26, 2021
Summary
Older adults with rib fractures may develop delayed hemothorax (dHTX) after initial imaging. This condition, often diagnosed post-discharge, requires wider recognition for accurate incidence rates.
Area of Science:
- Trauma surgery
- Thoracic medicine
- Geriatric emergency medicine
Background:
- Subtle hemothoraces can progress over days in older adults.
- Delayed development of traumatic hemothorax (dHTX) is not well understood.
- This study investigates dHTX in patients aged 50 and older.
Purpose of the Study:
- To characterize delayed hemothorax (dHTX) in older adults.
- To identify factors associated with dHTX development.
- To assess the incidence and clinical course of dHTX.
Main Methods:
- Retrospective review of patients ≥50 years with rib fractures and dHTX.
- dHTX defined as hemothorax discovered ≥48 hours after initial CT.
- Radiologists classified injury patterns using Chest Wall Injury Society (CWIS) taxonomy.
Main Results:
- Identified 14 patients with a pooled dHTX rate of 1.3%.
- 57% of patients were diagnosed after discharge, with a mean of 9 days post-discharge.
- Patients exhibited severe chest wall injury patterns, including multiple consecutive rib fractures.
Conclusions:
- Older adults with rib fractures may be at risk for delayed hemothorax progression.
- The true incidence of dHTX may be underestimated due to asymptomatic progression or readmission.
- Severe chest wall injury patterns may be linked to dHTX, warranting further investigation.
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