Retrospective Cohort Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Dec 28, 2018; 10(12): 184-189
Published online Dec 28, 2018. doi: 10.4329/wjr.v10.i12.184
Management of computed tomography scan detected hemothorax in blunt chest trauma: What computed tomography scan measurements say?
Mahdi Malekpour, Kenneth Widom, James Dove, Joseph Blansfield, Mohsen Shabahang, Denise Torres, Jeffrey L Wild
Mahdi Malekpour, Kenneth Widom, James Dove, Joseph Blansfield, Mohsen Shabahang, Denise Torres, Jeffrey L Wild, Department of Surgery, Section of Trauma and Acute Care Surgery, Geisinger Medical Center, Danville, PA 17822, United States
Author contributions: Malekpour M, Shabahang M and Wild JL designed of the Study; Malekpour M, Dove J and Blansfield J collected data; Widom K and Torres D analyzed the data; Malekpour M, Widom K, Dove J, Blansfield J, Shabahang M, Torres D and Wild JL prepared the draft and finalized the manuscript.
Institutional review board statement: Approved by Geisinger Institutional Review Board under the IRB # 2014-0533.
Informed consent statement: Due to anonymity of this research, patients were not required to provide a separate consent form as being approved by IRB of Geiringer Medical Center.
Conflict-of-interest statement: Authors included in this study have no conflict-of-interest and nothing to disclose.
Data sharing statement: No patient identification data is included in this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author to: Jeffrey L Wild, MD, Doctor, Staff Physician, Surgeon, Department of Surgery, Section of Trauma and Acute Care Surgery, Geisinger Medical Center, 100 North Academy Avenue, MC 21-69, Danville, PA 17822, United States. jlwild@geisinger.edu
Telephone: +1-570-2716361 Fax: +1-570-2717165
Received: June 5, 2018
Peer-review started: June 5, 2018
First decision: July 27, 2018
Revised: September 17, 2018
Accepted: November 24, 2018
Article in press: November 24, 2018
Published online: December 28, 2018
Processing time: 203 Days and 2.3 Hours
Abstract
AIM

To investigate the hemothorax size for which tube thoracostomy is necessary.

METHODS

Over a 5-year period, we included all patients who were admitted with blunt chest trauma to our level 1 trauma center. Focus was placed on identifying the hemothorax size requiring tube thoracostomy.

RESULTS

A total number of 274 hemothoraces were studied. All patients with hemothoraces measuring above 3 cm received a chest tube. The 50% predicted probability of tube thoracostomy was 2 cm. Pneumothorax was associated with odds of receiving tube thoracostomy for hemothoraces below 2 cm (Odds Ratio: 4.967, 95%CI: 2.225-11.097, P < 0.0001).

CONCLUSION

All patients with a hemothorax size greater than 3% underwent tube thoracostomy. Prospective studies are warranted to elucidate the clinical outcome of patients with smaller hemothoraces.

Keywords: Chest trauma; Blunt; Hemothorax; Chest tube; Occult; Computed tomography scan

Core tip: There is no clear recommendation for tube thoracostomy in hemothorax management based on computed tomography scan measurements. In this study, we found that any hemothoraces above the cut-off size of 3 cm should be drained using tube thoracostomy. Smaller hemothoraces may warrant drainage based on other findings such as presence of pneumothorax.