TUBE THORACOSTOMY COMPLICATIONS IN PATIENTS WITH ACUTE BLUNT THORACIC TRAUMA DUE TO ROAD TRAFFIC ACCIDENTS – "A COMPARATIVE STUDY"

Abstract

Abstract:

Objective:

To determine the differences in the frequency and types of Tube thoracostomy complications (TTCs) between two groups of patients (A and B) with blunt thoracic trauma (BTT), as a result of road traffic accidents (RTA).

 Study Design:

Prospective, comparative study.

Place and duration of Study:

Dawadmi General Hospital (DGH), a level II trauma center, Riyadh, from December 4, 2011 to December 3, 2012.

Methodology:

The problem of a high number and variety of TTCs resulting due to various technical aspects of tube thoracostomy (TT) are highlighted in this study. This is a prospective comparative study enrolling a total of 140 patients with BTT due to RTA, referred to this hospital with indwelling Tube thoracostomies (TTs) (group A) or undergoing TTs at this hospital (group B) by a single thoracic surgeon within 10-15 minutes of arrival. Patients' demographic and clinical details were recorded and confirmed with the referring physicians, if necessary. The two groups were matched for age, gender, indications for TTs and the number and types of accompanying injuries. Informed consent was obtained before the procedure. Results were analyzed using SPSS v 19. Statistical significance achieved was translated into p values at 95% confidence interval.

Results:

Of the 119 patients, who satisfied the inclusion criteria, group A had 49 (41.2%) and group B, 70 (58.8%) patients. Males were in the majority in both groups. A total of 130 chest tubes were placed in 119 patients. Contralateral chest tubes were indicated in 3 patients in group A and 8 patients in group B (table I). The overall TTCs rate was 61.5% (80/130), with the majority in group A (88.7%; p= 0.0001). The number of technical, infective and miscellaneous TTC in group A and B were 47 (92.2%), 6 (85.7%), 18 (81.8%), and 4 (7.8%), 1(14.3%), and 4 (18.2%), respectively (table II). The majority of the chest tubes in group A were smaller than 28 Fr (p=0.0001; RR=2.98; 95% CI=2.17-4.10). Mortality due to TT in groups A and B was 2% and 0%, respectively (P=0.416;RR=2.43;CI=1.96-3.01). Patients were followed up for 56 ±23 days after discharge.

Conclusion:

There is a significant difference in the frequency and types of TTCs for BTT due to RTA, between groups A and B. There is an urgent need to devise targeted training modules for emergency physicians with special emphasis on recognizing TTCs and having a low threshold for rectifying these before safe transfer to a higher center. In BTT the use of small caliber (< 24 Fr) tubes with trocars should be discouraged to avoid most complications.

Key words:

Tube thoracostomy complications (TTCs); Blunt thoracic trauma (BTT); Road traffic accident (RTA).