Abstract

Traumas are the leading cause of death in the first four decade of life. Thoracic trauma might lead to severe life-threatening complications. Tube thoracostomy is lifesaving procedure for these complications. Insertion of chest tube is an important approach in the Advanced Trauma Life Support. Objectives: The study was performed to evaluate outcome related to chest tube malposition, to assess the requirement of replacement of chest tube and to study the role of HRCT in post intercostal drain (ICD) patients. Methods: It was a retrospective observational study. The study was conducted on post ICD patients with persistent collapsed lungs for >3 days. Injury severity and patient outcomes were analyzed with respect to insertion environment, and the positions of chest tubes and necessity for replacement is assed after HRCT thorax. Results: Fifty patients who underwent chest tube replacement met the inclusion criteria. Majority of the patients were male (68%), age in between 40-49 years (40%) with blunt trauma (86%). Chest tubes were in the pleural space in 84% of cases. Most of the chest tubes (72%) were inserted in the resuscitation room. In the overall analysis, we found a significant trend (p=0.017) for longer hospital stay in patients without targeted chest tubes positions. Out-of-hospital chest tube insertion required higher replacement rates than resuscitation room insertions (57.1 vs 2.8%, p= <0.001). Conclusion: Patients with malposition of emergency chest tube according to CT were not associated with worse outcomes as most of the complications resolved spontaneously. Out- of-hospital chest tube insertions were associated with higher replacement rates compared to resuscitation room chest tube insertion. HRCT helps to identify any other lung injury/ involvement along with ICD malposition.

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