Residual hemothorax after chest tube placement correlates with increased risk of empyema following traumatic injury

Riyad Karmy-Jones, Michele Holevar, Ryan J. Sullivan, Gregory Jurkovich

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

Background: Empyema complicates tube thoracostomy following trauma in up to 10% of cases. Studies of potential risk factors of empyema have included use of antibiotics, site of injury and technique of chest tube placement. Residual fluid has also been cited as a risk factor for empyema, although the imaging technique to identify this varies. Objective: To determine whether residual hemothorax detected by chest x-ray (CXR) after one or more initial chest tubes predicts an increased risk of empyema. Methods: A study of patients admitted to two level I trauma centres between January 7, 2004, and December 3 1, 2004, was conducted. All patients who received a chest tube in the emergency department, did not undergo thoracotomy within 24 h, and survived more than two days were followed. Empyema was defined as a pleural effusion with positive cultures, and a ratio of pleural fluid lactate dehydrogenase to serum lactate dehydrogenase greater than 0.6 in the setting of elevated leukoeyte count and fever. Factors analyzed included the presence of retained hemothorax on CXR after the most recent tube placement in the emergency room, age, mechanism of injury and injury severity score. Results: A total of 102 patients met the criteria. Nine patients (9%) developed empyema: seven of 21 patients (33%) with residual hemothorax developed empyema versus two of 81 patients (2%) without residual hemothorax developed empyema (P=0.001). Injury severity score was significantly higher in those who developed empyema (31.4±26) versus those who did not (22.6±13; P=0.03). Conclusions: The presence of residual hemothorax detected by CXR after tube thoracostomy should prompt further efforts, including thoracoscopy, to drain it. With increasing injury severity, there may be increased benefit in terms of reducing empyema with this approach.

Original languageEnglish (US)
Pages (from-to)255-258
Number of pages4
JournalCanadian Respiratory Journal
Volume15
Issue number5
DOIs
StatePublished - Jan 1 2008
Externally publishedYes

Fingerprint

Hemothorax
Chest Tubes
Empyema
Wounds and Injuries
Thoracostomy
Injury Severity Score
Thorax
X-Rays
L-Lactate Dehydrogenase
Hospital Emergency Service
Thoracoscopy
Trauma Centers
Pleural Effusion
Thoracotomy
Fever
Anti-Bacterial Agents

Keywords

  • Empyema
  • Residual hemothorax
  • Tube thoracostomy

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Residual hemothorax after chest tube placement correlates with increased risk of empyema following traumatic injury. / Karmy-Jones, Riyad; Holevar, Michele; Sullivan, Ryan J.; Jurkovich, Gregory.

In: Canadian Respiratory Journal, Vol. 15, No. 5, 01.01.2008, p. 255-258.

Research output: Contribution to journalArticle

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abstract = "Background: Empyema complicates tube thoracostomy following trauma in up to 10{\%} of cases. Studies of potential risk factors of empyema have included use of antibiotics, site of injury and technique of chest tube placement. Residual fluid has also been cited as a risk factor for empyema, although the imaging technique to identify this varies. Objective: To determine whether residual hemothorax detected by chest x-ray (CXR) after one or more initial chest tubes predicts an increased risk of empyema. Methods: A study of patients admitted to two level I trauma centres between January 7, 2004, and December 3 1, 2004, was conducted. All patients who received a chest tube in the emergency department, did not undergo thoracotomy within 24 h, and survived more than two days were followed. Empyema was defined as a pleural effusion with positive cultures, and a ratio of pleural fluid lactate dehydrogenase to serum lactate dehydrogenase greater than 0.6 in the setting of elevated leukoeyte count and fever. Factors analyzed included the presence of retained hemothorax on CXR after the most recent tube placement in the emergency room, age, mechanism of injury and injury severity score. Results: A total of 102 patients met the criteria. Nine patients (9{\%}) developed empyema: seven of 21 patients (33{\%}) with residual hemothorax developed empyema versus two of 81 patients (2{\%}) without residual hemothorax developed empyema (P=0.001). Injury severity score was significantly higher in those who developed empyema (31.4±26) versus those who did not (22.6±13; P=0.03). Conclusions: The presence of residual hemothorax detected by CXR after tube thoracostomy should prompt further efforts, including thoracoscopy, to drain it. With increasing injury severity, there may be increased benefit in terms of reducing empyema with this approach.",
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