Development of posttraumatic empyema in patients with retained hemothorax: Results of a prospective, observational AAST study
Development of posttraumatic empyema in patients with retained hemothorax: Results of a prospective, observational AAST study
复制标题
DOI：
10.1097/ta.0b013e31825c1616
复制
发表时间：
2012-09-01
影响因子：
3.4
通讯作者：
Copwood, Ben
中科院分区：
文献类型：
--
作者：
DuBose, Joseph;Inaba, Kenji;Copwood, Ben
背景技术背景：残留血胸（RH）的自然史，特别是导致脓胸后续发展的因素，并不清楚。我们研究的目的是建立创伤和RH患者脓胸的现代发病率，并确定这种并发症发展的独立预测因素。方法：进行了一项美国创伤外科协会多中心前瞻性观察试验，招募了在创伤入院后24小时内放置胸廓造口管的患者，随后的RH发展在胸部计算机断层扫描中得到证实。分析了人口统计学、干预措施和结局。Logistic回归分析用于确定脓胸的发展的独立预测因素。结果：在20个参与中心的328例创伤后RH患者中，脓胸的总发病率为26.8%（n = 88）。回归分析显示肋骨骨折（调整后的比值比[OR]，2.3; 95%置信区间[CI]，1.3-4.1; p = 0.006），损伤严重度评分为25或更高（校正OR，2.4; 95% CI，1.3-4.4; p = 0.005），以及是否需要任何额外的治疗干预（校正OR，28.8; 95%CI，6.6-125.5; p < 0.001）被发现是创伤后RH患者脓胸发生的独立预测因素。脓胸患者也有一个明显更长的调整后的重症监护病房停留（校正的平均差异，4.1; 95% CI，1.3-6.9; p = 0.008）和住院时间（校正的平均差异，-7.9; 95% CI，-12.7至-3.2; p = 0.01）。创伤及创伤后RH患者中脓胸的发生率为26.8%。创伤后RH后脓胸发展的独立预测因素包括肋骨骨折、损伤严重度评分为25分或更高以及需要额外干预以排空胸腔内滞留的血液。我们的研究结果强调，需要通过选择最佳的初始疏散程序，以尽量减少与重症和RH患者的后续胸部手术相关的风险。（J Trauma Acute Care Surg.2012; 73：752-757.版权所有（C）2012 Lippincott威廉姆斯& Wilkins）
BACKGROUND: The natural history of retained hemothorax (RH), in particular factors contributing to the subsequent development of empyema, is not well known. The intent of our study was to establish the modern incidence of empyema among patients with trauma and RH and identify the independent predictors for development of this complication.METHODS: An American Association for the Surgery of Trauma multicenter prospective observational trial was conducted, enrolling patients with placement of a thoracostomy tube within 24 hours of trauma admission, and subsequent development of RH was confirmed on computed tomography of the chest. Demographics, interventions, and outcomes were analyzed. Logistic regression analysis was used to identify the independent predictors for the development of empyema.RESULTS: Among 328 patients with posttraumatic RH from the 20 participating centers, overall incidence of empyema was 26.8% (n = 88). On regression analysis, the presence of rib fractures (adjusted odds ratio [OR], 2.3; 95% confidence interval [CI], 1.3-4.1; p = 0.006), Injury Severity Score of 25 or higher (adjusted OR, 2.4; 95% CI, 1.3-4.4; p = 0.005), and the need for any additional therapeutic intervention (adjusted OR, 28.8; 95% CI, 6.6-125.5; p < 0.001) were found to be independent predictors for the development of empyema for patients with posttraumatic RH. Patients with empyema also had a significantly longer adjusted intensive care unit stay (adjusted mean difference, 4.1; 95% CI, 1.3-6.9; p = 0.008) and hospital stay (adjusted mean difference, -7.9; 95% CI, -12.7 to -3.2; p = 0.01).CONCLUSION: Among patients with trauma and posttraumatic RH, the incidence of empyema was 26.8%. Independent predictors of empyema development after posttraumatic RH included the presence of rib fractures, Injury Severity Score of 25 or higher, and the need for additional interventions to evacuate retained blood from the thorax. Our findings highlight the need to minimize the risk associated with subsequent thoracic procedures among patients with critical illness and RH, through selection of the most optimal procedure for initial evacuation. (J Trauma Acute Care Surg. 2012; 73: 752-757. Copyright (C) 2012 by Lippincott Williams & Wilkins)