Small Hemothoraces Not Drained on Admission: Initial Volume Predicts Need for Intervention

Area of Science:

• Trauma Surgery
• Thoracic Surgery
• Emergency Medicine

Background:

• Small hemothoraces (HTX) following blunt trauma are often managed non-operatively.
• Predictors for delayed intervention in initially observed small HTX require further investigation.

Purpose of the Study:

• To identify risk factors predicting the need for intervention in patients with small hemothorax (HTX) initially managed non-operatively after blunt trauma.

Main Methods:

• Retrospective review of patients with blunt traumatic HTX (2016-2022).
• Inclusion criteria: small HTX (<400 mL on CT) initially observed for >48 hours.
• Primary outcome: HTX-related intervention within 6 months; statistical analyses performed.

Main Results:

• 188 patients met criteria; 127 were initially observed, with 24% requiring intervention.
• Intervention group had larger initial HTX volume (129 mL vs 68 mL) and more rib fractures (7 vs 4).
• Number of rib fractures and HTX volume independently predicted the need for delayed intervention.

Conclusions:

• Initial HTX volume and number of rib fractures are significant predictors for delayed intervention in small HTX managed non-operatively.
• These factors can guide clinical decision-making for observation versus immediate intervention.