Evaluation of computed tomography-detected hemothorax after blunt chest trauma: Does everyone need an intervention?

Background

Diagnoses of Hemothorax, especially occult hemothorax, have increased after widespread use of computed tomography (CT) for imaging trauma patients. However, the need for chest tube insertion remains controversial. We aimed to study the management of hemothorax detected on CT among patients with blunt trauma, including the decision for tube thoracostomy, at Hamad level one trauma center.

METHODS

Patients with blunt chest trauma treated from June 2014 and January 2020 were e retrospectively studied. Variables on demographics, injury mechanism, severity, associated chest injuries, indications for tube thoracostomy, mechanical ventilation, hospital LOS, complications, and outcome were reviewed.

RESULTS

During the study period, 254 patients with hemothorax were studied. The majority of patients (79.1%) were successfully observed and tube thoracostomy was required in 20.9%. Hemithorax volume of less than 300 cc associated with successful observation (P value 0.001). Indications for chest tube insertion included progression of hemothorax on follow-up chest x-ray (15), desaturation (6), hemodynamic instability (2), and at the discretion of the physician (13). There were no complications related to delayed chest tube insertion.

CONCLUSION

Conservative treatment was safe and sufficient for most patients with hemothorax volume of less than 300 cc. Quantitative evaluation of hemothorax volume on CT scan should be considered in decision-making regarding tube thoracostomy insertion.

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