Management of simple and retained hemothorax: A practice management guideline from the Eastern Association for the Surgery of Trauma.

Journal Article (Journal Article;Systematic Review)

BACKGROUND: Traumatic hemothorax poses diagnostic and therapeutic challenges both acutely and chronically. A working group of the Eastern Association for the Surgery of Trauma convened to formulate a practice management guideline for traumatic hemothorax. METHODS: We formulated four questions: whether tube thoracostomy vs observation be performed, should pigtail catheter versus thoracostomy tube be placed to drain hemothorax, should thrombolytic therapy be attempted versus immediate thoracoscopic assisted drainage (VATS) in retained hemothorax (rHTX), and should early VATS (≤4 days) versus late VATS (>4 days) be performed? A systematic review was undertaken from articles identified in multiple databases. RESULTS: A total of 6391 articles were identified, 14 were selected for guideline construction. Most articles were retrospective with very low-quality evidence. We performed meta-analysis for some of the outcomes for three of the questions. CONCLUSIONS: For traumatic hemothorax we conditionally recommend pigtail catheters, in hemodynamically stable patients. In patients with rHTX, we conditionally recommend VATS rather than attempting thrombolytic therapy and recommend that it should be performed early (≤4 days).

Full Text

Duke Authors

Cited Authors

  • Patel, NJ; Dultz, L; Ladhani, HA; Cullinane, DC; Klein, E; McNickle, AG; Bugaev, N; Fraser, DR; Kartiko, S; Dodgion, C; Pappas, PA; Kim, D; Cantrell, S; Como, JJ; Kasotakis, G

Published Date

  • May 1, 2021

Published In

Volume / Issue

  • 221 / 5

Start / End Page

  • 873 - 884

PubMed ID

  • 33487403

Electronic International Standard Serial Number (EISSN)

  • 1879-1883

Digital Object Identifier (DOI)

  • 10.1016/j.amjsurg.2020.11.032


  • eng

Conference Location

  • United States