创伤性血胸残留的预测因素：东部创伤外科学会多机构试验的结果。
Predictors of retained hemothorax in trauma: Results of an Eastern Association for the Surgery of Trauma multi-institutional trial.
机构信息
From the Division of Trauma and Acute Care Surgery, Department of Surgery, University of Chicago Medical Center (P.S.P.), Chicago, IL; Division of Acute Care Surgery, Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM (S.A.M.); St. Michael's Hospital, University of Toronto, Department of Trauma & Acute Care Surgery (J.B.R-N., S.T.); UCHealth North, Medical Center of the Rockies, Loveland, CO (J.A.D., B.S.); Division of Trauma and Emergency Surgery, Department of Surgery, University of Texas Health Science Center at San Antonio (D.H.J.); Department of Surgery, University of Texas at Austin Dell Medical School, Austin, TX (T.C.); Division of Acute Care Surgery, Loma Linda University (K.M., J.F.), Loma Linda, CA; Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, Riverside University Health System, Moreno Valley, CA (R.C.); Department of General Surgery, Geisinger Medical Center, Danville, PA (J. Wild., K.Y.); Department of Surgery, University of Colorado School of Medicine, UCHealth Memorial Hospital, Colorado Springs, CO (T.J.S.); FACS Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, Riverside University Health System (R.C.), Moreno Valley, CA; Division of Trauma, Surgical Critical Care, and Burns, University of California San Diego, San Diego, CA (J.L.); University of Florida College of Medicine, Department of Surgery, Jacksonville, FL (D.J.S., M.J.S.); Envision Surgical Services, Medical City Plano Hospital, Plano, TX (M.M.C.); John Peter Smith Health Network, Associate Professor of Surgery, TCU & UNTHSC School of Medicine, Fort Worth, TX (F.O.M.); Arizona State University (J. Ward), Tempe, AZ; Department of Surgery, Division of Trauma, Surgical Critical Care and Acute Care Surgery, Tower Health, Reading Hospital, West Reading, PA (T.G., D.L.); LAC+USC Medical Center, Division of Trauma and Surgical Critical Care, Department of Surgery, Los Angeles, CA (A.P., K.I.); Division of Trauma and Critical Care, Medical College of Wisconsin, Milwaukee, WI (C.D.); Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin (B.G.); Kings County Hospital SUNY Downstate Medical Center, Brooklyn NY (T.S., S.S.); Ascension Via Christi Hospitals St. Francis, Department of Trauma Services, Wichita, KS (J.M.H., K.L.); Trauma, Acute Care Surgery & Surgical Critical Care, Methodist Dallas Medical Center (J.B., V.A.); and Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia (M.J.S., J.W.C.).
出版信息
J Trauma Acute Care Surg. 2020 Oct;89(4):679-685. doi: 10.1097/TA.0000000000002881.
BACKGROUND
The natural history of traumatic hemothorax (HTX) remains unclear. We aimed to describe outcomes of HTX following tube thoracostomy drainage and to delineate factors that predict progression to a retained hemothorax (RH). We hypothesized that initial large-volume HTX predicts the development of an RH.
METHODS
We conducted a prospective, observational, multi-institutional study of adult trauma patients diagnosed with an HTX identified on computed tomography (CT) scan with volumes calculated at time of diagnosis. All patients were managed with tube thoracostomy drainage within 24 hours of presentation. Retained hemothorax was defined as blood-density fluid identified on follow-up CT scan or need for additional intervention after initial tube thoracostomy placement for HTX.
RESULTS
A total of 369 patients who presented with an HTX initially managed with tube thoracostomy drainage were enrolled from 17 trauma centers. Retained hemothorax was identified in 106 patients (28.7%). Patients with RH had a larger median (interquartile range) HTX volume on initial CT compared with no RH (191 [48-431] mL vs. 88 [35-245] mL, p = 0.013) and were more likely to be older with a higher burden of thoracic injury. After controlling for significant differences between groups, RH was independently associated with a larger HTX on presentation, with a 15% increase in risk of RH for each additional 100 mL of HTX on initial CT imaging (odds ratio, 1.15; 95% confidence interval, 1.08-1.21; p < 0.001). Patients with an RH also had higher rates of pneumonia and longer hospital length of stay than those with successful initial management. Retained hemothorax was also associated with worse functional outcomes at discharge and first outpatient follow-up.
CONCLUSION
Larger initial HTX volumes are independently associated with RH, and unsuccessful initial management with tube thoracostomy is associated with worse patient outcomes. Future studies should use this experience to assess a range of options for reducing the risk of unsuccessful initial management.
LEVEL OF EVIDENCE
Therapeutic/care management study, level III.
背景
创伤性血胸（HTX）的自然病程仍不清楚。我们旨在描述胸腔引流后 HTX 的结果，并确定预测血胸持续存在（RH）的因素。我们假设初始大量 HTX 可预测 RH 的发生。
方法
我们进行了一项前瞻性、观察性、多机构研究，纳入了在 CT 扫描中诊断为 HTX 的成年创伤患者，在诊断时计算了 HTX 量。所有患者在出现 HTX 后 24 小时内接受胸腔引流管治疗。RH 定义为在初始胸腔引流放置后，通过随访 CT 扫描发现血密度液体或需要进一步干预的情况下出现的血胸。
结果
共有 369 名患者因 HTX 而就诊，最初接受胸腔引流管治疗，他们来自 17 个创伤中心。在 106 名患者（28.7%）中发现 RH。RH 患者的初始 CT 上 HTX 中位数（四分位数间距）较大（191[48-431]ml 比 88[35-245]ml，p=0.013），并且更有可能年龄较大，胸部损伤负担更高。在控制组间的显著差异后，RH 与 HTX 初始量较大独立相关，初始 CT 成像上每增加 100ml HTX，RH 的风险增加 15%（比值比，1.15；95%置信区间，1.08-1.21；p<0.001）。RH 患者的肺炎发生率和住院时间也长于初始治疗成功的患者。RH 患者出院时和首次门诊随访时的功能结局也较差。
结论
较大的初始 HTX 量与 RH 独立相关，胸腔引流管初始治疗不成功与患者预后较差相关。未来的研究应该利用这一经验来评估一系列降低初始管理失败风险的方案。
证据水平
治疗/护理管理研究，III 级。
Zotero 插件