Rossmann Marta, Altomare Michele, Pezzoli Isabella, Abruzzese Arianna, Spota Andrea, Vettorello Marco, Cioffi Stefano Piero Bernardo, Virdis Francesco, Bini Roberto, Chiara Osvaldo, Cimbanassi Stefania
General Surgery and Trauma Team, ASST GOM Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy.
Department of Surgical Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy.
J Pers Med. 2022 Sep 23;12(10):1570. doi: 10.3390/jpm12101570.
Thoracic trauma occurs in 20-25% of all trauma patients worldwide and represents the third cause of trauma-related mortality. Retained hemothorax (RH) is defined as a residual hematic pleural effusion larger than 500 mL after 72 h of treatment with a thoracic tube. The aim of this study is to investigate risk factors for the development of RH in thoracic trauma and predictors of surgery. A retrospective, observational, monocentric study was conducted in a Trauma Hub Hospital in Milan, recording thoracic trauma from January 2011 to December 2020. Pre-hospital peripheric oxygen saturation (SpO) was significantly lower in the RH group (94% vs. 97%, = 0.018). Multivariable logistic regression analysis identified, as independent predictors of RH, sternum fracture (OR 7.96, 95% CI 1.16-54.79; = 0.035), pre-admission desaturation (OR 0.96; 95% CI 0.77-0.96; = 0.009) and the number of thoracic tube maintenance days (OR 1.22; 95% CI 1.09-1.37; = 0.0005). The number of tubes placed and the 1° rib fracture were both significantly associated with the necessity of surgical treatment of RH (2 vs. 1, = 0.004; 40% vs. 0%; = 0.001). The risk of developing an RH in thoracic trauma should not be underestimated. Variables related to RH must be taken into account in order to schedule a proper follow-up after trauma.
全球范围内，20%-25%的创伤患者会发生胸部创伤，胸部创伤是创伤相关死亡的第三大原因。保留性血胸（RH）定义为胸腔闭式引流治疗72小时后残留的血性胸腔积液大于500 mL。本研究旨在调查胸部创伤中RH发生的危险因素及手术预测因素。在米兰一家创伤中心医院进行了一项回顾性、观察性、单中心研究，记录了2011年1月至2020年12月期间的胸部创伤情况。RH组院前外周血氧饱和度（SpO）显著更低（94%对97%，P = 0.018）。多变量逻辑回归分析确定，胸骨骨折（比值比7.96，95%置信区间1.16-54.79；P = 0.035）、入院前血氧饱和度下降（比值比0.96；95%置信区间0.77-0.96；P = 0.009）和胸腔闭式引流维持天数（比值比1.22；95%置信区间1.09-1.37；P = 0.0005）是RH的独立预测因素。放置的引流管数量和第1肋骨骨折均与RH手术治疗的必要性显著相关（2对1，P = 0.004；40%对0%；P = 0.001）。胸部创伤中发生RH的风险不应被低估。为了在创伤后安排适当的随访，必须考虑与RH相关的变量。
