Sritharen Yoginee, Hernandez Matthew C, Haddad Nadeem N, Kong Victor, Clarke Damian, Zielinski Martin D, Aho Johnathon M
Division of Trauma, Critical Care, and General Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Department of Surgery, Pietermaritzburg Metropolitan Complex, University of Kwa-Zulu Natal, Durban, South Africa.
World J Surg. 2018 Mar;42(3):736-741. doi: 10.1007/s00268-017-4260-8.
Tube thoracostomy (TT) is a commonly performed procedure which is associated with significant complication rates. Currently, there is no validated taxonomy to classify and compare TT complications across different populations. This study aims to validate such TT complication taxonomy in a cohort of South African trauma patients.
Post hoc analysis of a prospectively collected trauma database from Pietermaritzburg Metropolitan Trauma Service (PMTS) in South Africa was performed for the period January 2010 to December 2013. Baseline demographics, mechanism of injury and complications were collected and categorized according to published classification protocols. All patients requiring bedside TT were included in the study. Patients who necessitated operatively placed or image-guided TT insertion were excluded. Summary and univariate analyses were performed.
A total of 1010 patients underwent TT. The mean age was (±SD) of 26 ± 8 years. Unilateral TTs were inserted in n = 966 (96%) and bilateral in n = 44 (4%). Complications developed in 162 (16%) patients. Penetrating injury was associated with lower complication rate (11%) than blunt injury (26%), p = 0.0001. Higher complication rate was seen in TT placed by interns (17%) compared to TT placed by residents (7%), p = 0.0001. Complications were classified as: insertional (38%), positional (44%), removal (9%), infective/immunologic (9%), and instructional, educational or equipment related (0%).
Despite being developed in the USA, this classification system is robust and was able to comprehensively assign and categorize all the complications of TT in this South African trauma cohort. A universal standardized definition and classification system permits equitable comparisons of complication rates. The use of this classification taxonomy may help develop strategies to improve TT placement techniques and reduce the complications associated with the procedure.
V.
Single Institution Retrospective review.
胸腔闭式引流术（TT）是一种常见的操作，但其并发症发生率较高。目前，尚无经过验证的分类法来对不同人群的TT并发症进行分类和比较。本研究旨在验证南非创伤患者队列中的此类TT并发症分类法。
对南非彼得马里茨堡市大都会创伤服务中心（PMTS）2010年1月至2013年12月前瞻性收集的创伤数据库进行事后分析。根据已发表的分类方案收集基线人口统计学数据、损伤机制和并发症并进行分类。所有需要床边TT的患者均纳入研究。需要手术放置或影像引导下TT置入的患者被排除。进行了总结分析和单因素分析。
共有1010例患者接受了TT。平均年龄（±标准差）为26±8岁。966例（96%）患者进行了单侧TT置入，44例（4%）患者进行了双侧TT置入。162例（16%）患者出现并发症。穿透伤的并发症发生率（11%）低于钝性伤（26%），p = 0.0001。实习医生放置的TT并发症发生率（17%）高于住院医生放置的TT（7%），p = 0.0001。并发症分类如下：置入相关（38%）；位置相关（44%）；拔除相关（9%）；感染/免疫相关（9%）；指导、教育或设备相关（0%）。
尽管该分类系统是在美国开发的，但它很可靠，能够全面地对这个南非创伤队列中TT的所有并发症进行分类。通用标准化定义和分类系统允许对并发症发生率进行公平比较。使用这种分类法可能有助于制定策略，以改进TT放置技术并减少与该操作相关的并发症。
V。
单机构回顾性研究。
