Computed tomography-detected hemothorax after blunt chest trauma: Does everyone need an intervention? A retrospective analysis
<h3 dir="ltr">Background</h3><p dir="ltr">The frequent use of computed tomography (CT) scan in the evaluation of trauma patients has led to an increase in the diagnosis of hemothorax. This study aimed to assess whether a <u>hemothorax </u>volume of &...
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2025
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| Summary: | <h3 dir="ltr">Background</h3><p dir="ltr">The frequent use of computed tomography (CT) scan in the evaluation of trauma patients has led to an increase in the diagnosis of hemothorax. This study aimed to assess whether a <u>hemothorax </u>volume of <300 ml, as determined by CT imaging, can be managed without tube <u>thoracostomy </u>and to identify the factors that recommend its use. </p><h3 dir="ltr">Methods</h3><p dir="ltr">A retrospective observational study was conducted at XXX Trauma Center, including all patients with traumatic hemothorax from June 2014 to January 2020. Patient demographics, injury mechanism, severity, associated <u>chest injuries</u>, indications for tube thoracostomy, <u>mechanical ventilation</u>, hospital length of stay, complications, and outcomes were reviewed. The study compared patients with hemothorax volumes < 300 ml and ≥300 ml and assessed the outcomes of conservative management without tube thoracostomy (conservative management) vs therapeutic management with tube thoracostomy placement (failed observation). </p><h3 dir="ltr">Results</h3><p dir="ltr">A total of 254 patients with hemothorax were included. Most patients (79 %) were successfully managed without tube thoracostomy insertion, while 53 patients (21 %) required tube thoracostomy after failure of conservative management. Patients with larger hemothorax volumes were significantly more likely to require tube thoracostomy (<i>p</i> = 0.001) and had significantly longer hospital stays (<i>p</i> = 0.021). Those with failed observation had higher<u> injury severity scores</u> (<i>p</i> = 0.001), more associated <u>lung contusions</u> (<i>p</i> = 0.015), <u>pneumothorax</u> (<i>p</i> = 0.024), and <u>rib fractures</u> (<i>p</i> = 0.001). They also had larger hemothorax volumes (<i>p</i> = 0.001), a greater need for mechanical ventilation (<i>p</i> = 0.001), and prolonged hospitalization (<i>p</i>= 0.001). Predictors of failed observation included high hemothorax volume (≥300 ml), ISS, and greater number of fractured ribs. </p><h3 dir="ltr">Conclusion</h3><p dir="ltr">Conservative management (without tube thoracostomy) was adequate for most patients with <300 ml of hemothorax volumes. Quantitative assessment of hemothorax volume should be considered part of the clinical decision-making algorithm. Further research is needed to refine management strategies and improve outcomes for traumatic hemothorax.</p><h2 dir="ltr">Other Information</h2><p dir="ltr">Published in: Injury<br>License: <a href="http://creativecommons.org/licenses/by/4.0/" target="_blank">http://creativecommons.org/licenses/by/4.0/</a><br>See article on publisher's website: <a href="https://dx.doi.org/10.1016/j.injury.2025.112532" target="_blank">https://dx.doi.org/10.1016/j.injury.2025.112532</a></p> |
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