R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland 21201, USA.
J Trauma Acute Care Surg. 2012 Sep;73(3):752-7. doi: 10.1097/TA.0b013e31825c1616.
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.
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.
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).
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.
Prognostic study, level III.
保留性血胸（RH）的自然病史，尤其是导致随后发生脓胸的因素，尚不清楚。本研究的目的是确定创伤后伴有 RH 的患者中脓胸的现代发病率，并确定发生这种并发症的独立预测因素。
进行了美国创伤外科学会多中心前瞻性观察性试验，纳入了创伤后 24 小时内放置胸腔引流管的患者，随后通过胸部计算机断层扫描确认 RH。分析了人口统计学、干预措施和结果。采用 logistic 回归分析确定脓胸发生的独立预测因素。
在来自 20 个参与中心的 328 例创伤后 RH 患者中，脓胸总发生率为 26.8%（n=88）。回归分析显示，存在肋骨骨折（校正优势比[OR]，2.3；95%置信区间[CI]，1.3-4.1；p=0.006）、损伤严重程度评分≥25（校正 OR，2.4；95%CI，1.3-4.4；p=0.005）和需要任何其他治疗干预（校正 OR，28.8；95%CI，6.6-125.5；p<0.001）是创伤后 RH 患者发生脓胸的独立预测因素。脓胸患者的 ICU 住院时间（校正平均差值，4.1；95%CI，1.3-6.9；p=0.008）和住院时间（校正平均差值，-7.9；95%CI，-12.7 至-3.2；p=0.01）也明显延长。
在创伤和创伤后 RH 的患者中，脓胸的发生率为 26.8%。创伤后 RH 后脓胸发生的独立预测因素包括肋骨骨折、损伤严重程度评分≥25 和需要额外干预以从胸腔中清除残留血液。我们的研究结果强调，需要通过选择最优化的初始引流程序来降低患有危重病和 RH 的患者随后进行的胸部手术的风险。
预后研究，III 级。
