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Meta-Analysis
. 2024 Oct 1;97(4):631-638.
doi: 10.1097/TA.0000000000004412. Epub 2024 Aug 30.

Small versus large-bore thoracostomy for traumatic hemothorax: A systematic review and meta-analysis

Nicole B Lyons  1 , Mohamed O Abdelhamid, Brianna L Collie, Walter A Ramsey, Christopher F O'Neil, Jessica M Delamater, Michael D Cobler-Lichter, Larisa Shagabayeva, Kenneth G Proctor, Nicholas Namias, Jonathan P Meizoso
Affiliations
Meta-Analysis

Small versus large-bore thoracostomy for traumatic hemothorax: A systematic review and meta-analysis

Nicole B Lyons et al. J Trauma Acute Care Surg. .

Abstract

Background: Traumatic hemothorax (HTX) is common, and while it is recommended to drain it with a tube thoracostomy, there is no consensus on the optimal catheter size. We performed a systematic review to test the hypothesis that small bore tube thoracostomy (SBTT) (≤14 F) is as effective as large-bore tube thoracostomy (LBTT) (≥20F) for the treatment of HTX.

Methods: Pubmed, EMBASE, Scopus, and Cochrane review were searched from inception to November 2022 for randomized controlled trials or cohort studies that included adult trauma patients with HTX who received a tube thoracostomy. Data was extracted and Critical Appraisal Skills Program checklists were used for study appraisal. The primary outcome was failure rate, defined as incompletely drained or retained HTX requiring a second intervention. Cumulative analysis was performed with χ 2 test for dichotomous variables and an unpaired t-test for continuous variables. Meta-analysis was performed using a random effects model.

Results: There were 2,008 articles screened, of which nine were included in the analysis. The studies included 1,847 patients (714 SBTT and 1,233 LBTT). The mean age of patients was 46 years, 75% were male, average ISS was 20, and 81% had blunt trauma. Failure rate was not significantly different between SBTT (17.8%) and LBTT (21.5%) ( p = 0.166). Additionally, there were no significant differences between SBTT vs. LBTT in mortality (2.9% vs. 6.1%, p = 0.062) or complication rate (12.3% vs. 12.5%, p = 0.941), however SBTT had significantly higher initial drainage volumes (753 vs. 398 mL, p < 0.001) and fewer tube days (4.3 vs. 6.2, p < 0.001). There are several limitations. Some studies did not report all the outcomes of interest, and many of the studies are subject to selection bias.

Conclusion: SBTT may be as effective as LBTT for the treatment of traumatic HTX.

Level of evidence: Systematic Review/Meta-Analysis; Level IV.

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References

    1. Patel NJ, Dultz L, Ladhani HA, et al. Management of simple and retained hemothorax: a practice management guideline from the Eastern Association for the Surgery of Trauma. Am J Surg 2021;221(5):873–884.
    1. Chang SH, Kang YN, Chiu HY, Chiu YH. A systematic review and meta-analysis comparing pigtail catheter and chest tube as the initial treatment for pneumothorax. Chest 2018;153(5):1201–1212.
    1. Kulvatunyou N, Erickson L, Vijayasekaran A, et al. Randomized clinical trial of pigtail catheter versus chest tube in injured patients with uncomplicated traumatic pneumothorax. Br J Surg 2014;101(2):17–22.
    1. Kulvatunyou N, Joseph B, Friese RS, et al. 14 French pigtail catheters placed by surgeons to drain blood on trauma patients: is 14-Fr too small? J Trauma Acute Care Surg 2012;73(6):1423–7.
    1. Bauman ZM, Kulvatunyou N, Joseph B, et al. Randomized clinical trial of 14-French (14F) pigtail catheters versus 28-32F chest tubes in the management of patients with traumatic hemothorax and hemopneumothorax. World J Surg 2021;45(3):880–886.