Predictors of chest drainage complications in trauma patients

ABSTRACT Objective: to identify predictors of chest drainage complications in trauma patients attended at a University Hospital. Methods: we conducted a retrospective study of 68 patients submitted to thoracic drainage after trauma, in a one-year period. We analyzed gender, age, trauma mechanism, trauma indices, thoracic and associated lesions, environment in which the procedure was performed, drainage time, experience of the performer, complications and evolution. Results: the mean age of the patients was 35 years and the male gender was the most prevalent (89%). Blunt trauma was the most frequent, with 67% of cases, and of these, 50% were due to traffic accidents. The mean TRISS (Trauma and Injury Severity Score) was 98, with a mortality rate of 1.4%. The most frequent thoracic and associated lesions were, respectively, rib fractures (51%) and abdominal trauma (32%). The mean drainage time was 6.93 days, being higher in patients under mechanical ventilation (p=0.0163). The complication rate was 26.5%, mainly poor drain positioning (11.77%). Hospital drainage was performed in 89% of cases by doctors in the first year of specialization. Thoracic drainage performed in prehospital care presented nine times more chances of complications (p=0.0015). Conclusion: the predictors of post-trauma complications for chest drainage were a procedure performed in an adverse site and mechanical ventilation. The high rate of complications demonstrates the importance of protocols of care with the thoracic drainage.摘要 研究目的：旨在识别某大学医院收治的创伤患者胸腔引流并发症的预测因素。 方法：本研究为回顾性研究，纳入一年内因创伤接受胸腔引流的68例患者，分析内容涵盖性别、年龄、创伤机制、创伤相关指标、胸部及合并损伤、手术操作环境、引流时长、术者从业经验、并发症发生情况及患者转归。 结果：患者平均年龄为35岁，男性占比最高（89%）。钝性创伤最为常见，占比67%，其中50%由交通事故引发。患者平均TRISS（创伤与损伤严重程度评分，Trauma and Injury Severity Score）为98，总死亡率为1.4%。最常见的胸部损伤及合并损伤分别为肋骨骨折（51%）与腹部创伤（32%）。平均引流时长为6.93天，接受机械通气患者的引流时长显著更长（p=0.0163）。并发症发生率为26.5%，其中以引流管位置不当最为多见（11.77%）。89%的院内胸腔引流操作由入职第一年的专科医师完成。院前实施的胸腔引流术发生并发症的风险是院内操作的9倍（p=0.0015）。 结论：创伤后胸腔引流并发症的预测因素为院前操作与机械通气。较高的并发症发生率凸显了胸腔引流护理规范的重要性。