The insertion of a chest tube is a common procedure in trauma care, and the Advanced Trauma Life Support program teaches the insertion of chest tubes as an essential and life-saving skill. The purpose of this study by a group of collaborators, including Drs. Russell Griffin and Gerald McGwin, both from the Department of Epidemiology from University of Alabama at Birmingham School of Public Health, was to evaluate complications of chest tube placement in a level 1 trauma center compared with those placed in surrounding referral hospitals.
A retrospective matched cohort study of trauma patients was performed between those who underwent chest tube placement at the level 1 trauma center and those with a chest tube placed before transfer to the level 1 center between 2004 and 2013. Conditional logistic regression was used to compare the likelihood of complications and death between chest tube placement groups.
Four thousand two hundred and sixteen trauma patients had a chest tube placed at the level 1 center, and 364 patients had a chest tube placed at an outside hospital before transfer. Patients with a chest tube placed outside the trauma center had an increased likelihood of malposition, residual hemothorax, residual pneumothorax, and having a second chest tube placed. However, the patients with a chest tube placed outside of the trauma center were also less likely to develop pneumonia.
There are opportunities for improving the care of patients who require chest tubes at both referring hospitals and the receiving trauma center. Improving the care of patients who require intercostal drainage requires a systems-based approach, focusing on training and quality improvement.Friday Letter Submission