Sethuraman Kinjal N, Duong David, Mehta Supriya, Director Tara, Crawford Darcey, St George Jill, Rathlev Niels K
Department of Emergency Medicine, Long Island Jewish Medical Center, New Hyde Park, NY, USA.
J Emerg Med. 2011 Jan;40(1):14-20. doi: 10.1016/j.jemermed.2008.06.033. Epub 2008 Dec 20.
Emergency medicine residents frequently perform invasive procedures, including tube thoracostomy (TT), that inherently place patients at risk for complications.
The purpose of the study was to assess the prevalence and types of complications from TT in an academic emergency department (ED).
A combined prospective and retrospective, observational study of all patients who had TT between December 2002 and January 2006 was performed. Exclusion criteria included age < 15 years and tube placement at an outside facility. Complications detected in the ED were defined as immediate, whereas those discovered later were defined as delayed. Complications requiring corrective surgical intervention, administration of blood products, or intravenous antibiotics were defined as major. Bivariate and multivariate analyses were used to identify operator and patient factors associated with complications.
TTs were placed in 242 patients, and 90 (37%; 95% confidence interval [CI] 31.1-43.3%) experienced a complication. Major complications included one intercostal artery laceration, one retroperitoneal placement, and empyema in 2 patients. In multivariate analysis, blunt injury excluding motor vehicle accidents (odds ratio [OR] 2.57; 95% CI 1.27-5.21) and spontaneous pneumothorax (OR 3.84; 95% CI 1.80-8.18) were associated with all complications. TT size < 36 French and blunt injury excluding motor vehicle accidents were associated with immediate complications and spontaneous pneumothorax was associated with delayed complications.
The vast majority of complications from TT in the ED were minor. The prevalence of complications was consistent with previous reports of TTs placed by non-emergency-medicine-trained physicians outside the ED. The findings can be used to identify avoidable complications and improve residency training.
急诊医学住院医师经常进行侵入性操作，包括胸腔闭式引流术（TT），这些操作本身会使患者面临并发症风险。
本研究旨在评估学术性急诊科（ED）中胸腔闭式引流术并发症的发生率及类型。
对2002年12月至2006年1月期间所有接受胸腔闭式引流术的患者进行前瞻性与回顾性相结合的观察性研究。排除标准包括年龄小于15岁以及在外院进行的置管操作。在急诊科检测到的并发症定义为即时并发症，而后来发现的并发症定义为延迟并发症。需要进行纠正性手术干预、输注血液制品或静脉使用抗生素的并发症定义为严重并发症。采用双变量和多变量分析来确定与并发症相关的操作者和患者因素。
242例患者接受了胸腔闭式引流术，其中90例（37%；95%置信区间[CI] 31.1 - 43.3%）出现并发症。严重并发症包括1例肋间动脉撕裂、1例腹膜后置管以及2例患者发生脓胸。在多变量分析中，不包括机动车事故的钝性伤（优势比[OR] 2.57；95% CI 1.27 - 5.21）和自发性气胸（OR 3.84；95% CI 1.80 - 8.18）与所有并发症相关。小于36法式的胸腔闭式引流管尺寸以及不包括机动车事故的钝性伤与即时并发症相关，而自发性气胸与延迟并发症相关。
急诊科胸腔闭式引流术的绝大多数并发症为轻微并发症。并发症的发生率与之前非急诊医学专业培训医生在急诊科外进行胸腔闭式引流术的报告一致。这些发现可用于识别可避免的并发症并改进住院医师培训。
