Predictors of retained hemothorax in trauma: Results of an Eastern Association for the Surgery of Trauma multi-institutional trial
Predictors of retained hemothorax in trauma: Results of an Eastern Association for the Surgery of Trauma multi-institutional trial
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DOI：
10.1097/ta.0000000000002881
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发表时间：
2020-10-01
影响因子：
3.4
通讯作者：
Cannon, Jeremy W.
中科院分区：
文献类型：
--
作者：
Prakash, Priya S.;Moore, Sarah A.;Cannon, Jeremy W.
背景创伤性血胸(HTX)的自然病史尚不清楚。我们的目的是描述胸腔置管引流术后HTX的结果，并描述预测进展为残留性血胸(RH)的因素。我们假设最初的大容量HTX可以预测RH的发展。方法对CT诊断为HTX的成人创伤患者进行前瞻性、观察性、多机构研究，诊断时计算体积。所有患者均于发病后24小时内行胸腔置管引流。血胸滞留定义为随访CT扫描发现的血液密度液，或HTX首次胸腔造口术后需要额外干预。结果共有来自17个创伤中心的369名患者入选，这些患者最初接受了胸腔置管引流。106例(28.7%)发现血胸滞留。与无RH的患者相比，有RH的患者在初始CT上有更大的中位数(四分位数范围)HTX体积(191mLvs.88[35-245]mL，p=0.013)，并且更有可能年龄更大，胸部损伤的负担更重。在控制了不同组之间的显著差异后，RH独立地与出现较大的HTX相关，初始CT成像中每增加100mLHTX，RH的风险增加15%(优势比为1.15；95%可信区间为1.08-1.21；p<；0.001)。RH患者的肺炎发生率和住院时间也比那些最初治疗成功的患者更高。血胸滞留也与出院时和第一次门诊随访时的功能结果较差有关。结论较大的初始HTX容量与RH独立相关，而管状胸腔造口术的初始处理不成功与患者预后较差有关。未来的研究应该利用这一经验来评估一系列降低初始管理失败风险的选择。
BACKGROUND The natural history of traumatic hemothorax (HTX) remains unclear. We aimed to describe outcomes of HTX following tube thoracostomy drainage and to delineate factors that predict progression to a retained hemothorax (RH). We hypothesized that initial large-volume HTX predicts the development of an RH. METHODS We conducted a prospective, observational, multi-institutional study of adult trauma patients diagnosed with an HTX identified on computed tomography (CT) scan with volumes calculated at time of diagnosis. All patients were managed with tube thoracostomy drainage within 24 hours of presentation. Retained hemothorax was defined as blood-density fluid identified on follow-up CT scan or need for additional intervention after initial tube thoracostomy placement for HTX. RESULTS A total of 369 patients who presented with an HTX initially managed with tube thoracostomy drainage were enrolled from 17 trauma centers. Retained hemothorax was identified in 106 patients (28.7%). Patients with RH had a larger median (interquartile range) HTX volume on initial CT compared with no RH (191 [48-431] mL vs. 88 [35-245] mL,p= 0.013) and were more likely to be older with a higher burden of thoracic injury. After controlling for significant differences between groups, RH was independently associated with a larger HTX on presentation, with a 15% increase in risk of RH for each additional 100 mL of HTX on initial CT imaging (odds ratio, 1.15; 95% confidence interval, 1.08-1.21;p< 0.001). Patients with an RH also had higher rates of pneumonia and longer hospital length of stay than those with successful initial management. Retained hemothorax was also associated with worse functional outcomes at discharge and first outpatient follow-up. CONCLUSION Larger initial HTX volumes are independently associated with RH, and unsuccessful initial management with tube thoracostomy is associated with worse patient outcomes. Future studies should use this experience to assess a range of options for reducing the risk of unsuccessful initial management.