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Western Trauma Association critical decisions in trauma: Traumatic hemothorax
Allyson M Hynes1, Carlos V R Brown, Jennifer L Hartwell
1Department of Surgery, Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin (A.M.H., M.A.de M.); Department of Surgery and Perioperative Care, Division of Acute Care Surgery, The University of Texas at Austin Dell Medical School, Austin, Texas (C.V.R.B.); Department of Surgery, Division of Acute Care Surgery, University of Kansas Medical Center, Kansas City, Kansas (J.L.H.); Department of Surgery, Division of Acute Care Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California (K.I., M.J.M.); Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland (E.J.L., D.M.S.); Department of Surgery, Division of GI, Trauma, and Endocrine Surgery, University of Colorado Anschutz, Aurora, Colorado (E.E.M.); The Guthrie Clinic, Sayre (A.G.R.); Department of Surgery, Division of Trauma and General Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania (J.L.S.); Department of Surgery, Creighton University School of Medicine Phoenix Campus, Phoenix, Arizona, Pennsylvania (J.A.W.).
Abstract:
Traumatic hemothorax is a common consequence of thoracic injury, with management strategies ranging from observation to tube thoracostomy and operative intervention. This Western Trauma Association algorithm provides a practical framework for the evaluation and management of patients with traumatic hemothorax. Recommendations were developed through review of the available literature, including randomized and observational studies, supplemented by expert consensus where high-quality evidence is limited. The proposed pathway incorporates patient physiology, hemothorax size, adequacy of pleural drainage, and evidence of ongoing hemorrhage to guide management decisions. Because clinical circumstances, institutional resources, and local practice patterns vary, the algorithm is intended to support rather than replace individualized clinical judgment. It may be used as a bedside reference and as a framework for the development of institution-specific protocols.
Level Of Evidence:
Consensus algorithm from the Western Trauma Association; Level V.