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Early Chest Drain Management in Trauma

Balhorn J and MacCormick AD

Background: Tube thoracostomy is an essential skill, and in thoracic trauma can be lifesaving. Yet a complication rate of up to 30% has been widely reported in the literature. Our primary aim was to look at the complication rate associated with chest drain insertion in trauma patients at our institution. Our secondary objectives included indications for tube thoracostomy and the differences in complications across specialties. Methods: Over a 24-month period we performed a retrospective analysis of all trauma patients admitted to Middlemore Hospital, a tertiary urban hospital in New Zealand. The study group included all patients who potentially required tube thoracostomy for trauma. Complications were deemed positional, infective or insertional. Indication for chest drain was identified by cross referencing a patient’s radiological findings with clinical presentation. Results: Of 127 patients in the study group, 59 chest drains were inserted in 56 patients. The complication rate was 22%; 12 were positional, 1 was infective, and there were no insertional complications. General Surgical Registrars inserted approximately one-third of the chest drains, and accounted for 62% of the complications. Patients with large PTX on initial CXR findings had much lower complication rates (4%) than those without (37%). Discussion: Almost one in four patients that received a chest drain had a complication, and General Surgery accounted for the majority of these. When indications for chest drains are clinical, the complication rate is higher. A prospective study aiming to reduce complications, by implementing a checklist similar to the WHO surgical safety checklist is planned.