Predictors of pleural complications in trauma patients undergoing tube thoracostomy: A prospective observational study

ABSTRACT Objective: to identify variables related to pleural complications in patients undergoing tube thoracostomies due to traumatic injuries. Method: we conducted a prospective observational study from May/2019 to January/2021 including adult trauma patients submitted to tube thoracostomies after hospital admission. Patients undergoing thoracotomies as the initial treatment were not included. We excluded patients with suspected and confirmed COVID-19 diagnosis during the hospitalization. Pleural complications were defined as clotted hemothorax, residual pneumothorax and empyema. Students t, Mann Whitneys, Chi square and Fishers exact test were used to compare variables between groups. We considered p&lt;0.05 as significant. Results: we analyzed 68 patients. The mean age was 36.0 + 12.6 years and 91.2% were male. The mean RTS and ISS were, respectively, 7.0 ± 1.6 and 15.9 ± 7.6. The most frequent trauma mechanism was stab wounds in 50.0%, followed by blunt trauma in 38.2%. The severity of thoracic injuries was stratified (AIS) as 2 (4.4%), 3 (80.9%), 4 (13.2%), e 5 (1.5%). Pleural complications happened in 14 (20.5%) patients, being clotted / residual hemothorax (11.8%), residual pneumothorax (4.4%), empyema (2.9%) and miscellaneous (1.4%). These patients were treated by thoracoscopy (5), thoracotomy (3), chest re-drainage (3) and clinical measures alone (3). There was a significant association between pleural complications with the time of permanence (p&lt;0,001) and the necessity of relocation (p&lt;0,001) of the drain. Conclusion: the predictors of pleural complications in this series were time of permanence and the necessity of relocation of the drain.摘要 研究目的：明确因创伤性损伤接受胸腔闭式引流术患者发生胸膜并发症的相关影响变量。研究方法：本研究为2019年5月至2021年1月开展的前瞻性观察研究，纳入入院后接受胸腔闭式引流术的成年创伤患者；排除初始治疗即行开胸手术的患者，以及住院期间确诊或疑似新型冠状病毒肺炎（COVID-19）的患者。本研究将胸膜并发症定义为凝固性血胸、残留气胸及脓胸。采用两独立样本t检验、曼-惠特尼U检验、卡方检验及费舍尔精确检验进行组间变量比较，以P<0.05为差异具有统计学意义。研究结果：本研究共纳入68例患者，平均年龄为36.0±12.6岁，其中男性占比91.2%。创伤评分（Revised Trauma Score, RTS）与损伤严重度评分（Injury Severity Score, ISS）的平均值分别为7.0±1.6与15.9±7.6。最常见的创伤机制为刺伤（50.0%），其次为钝性创伤（38.2%）。胸部损伤严重程度依据简明损伤定级标准（Abbreviated Injury Scale, AIS）进行分级：2级（4.4%）、3级（80.9%）、4级（13.2%）及5级（1.5%）。共有14例（20.5%）患者发生胸膜并发症，其中凝固性/残留血胸占11.8%、残留气胸占4.4%、脓胸占2.9%，其余为其他类型并发症（1.4%）。上述并发症患者的治疗方式包括胸腔镜手术（5例）、开胸手术（3例）、胸腔引流管重置术（3例）及单纯临床保守治疗（3例）。分析显示，胸膜并发症与引流管留置时间（P<0.001）及引流管重置需求（P<0.001）存在显著关联。研究结论：本研究队列中胸膜并发症的预测因素为引流管留置时间与引流管重置需求。