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Year : 2018  |  Volume : 8  |  Issue : 4  |  Page : 166-170

Thoracostomy tube in trauma surgery: Does position really matter?

1 Department of Surgery, Barau Dikko Teaching Hospital and Kaduna State University, Kaduna, Nigeria
2 Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
3 Department of Surgery, University of Uyo Teaching Hospital, Uyo, Nigeria

Correspondence Address:
Dr. Jerry G Makama
Department of Surgery, Barau Dikko Teaching Hospital and Kaduna State University, Kaduna
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ais.ais_17_19

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Background: In chest trauma, the conditions that compromise breathing very fast include hemothorax (HTx), pneumothorax (PTx), or both (HPTx). Fortunately, these conditions can be managed with tube thoracostomy (TT). This study was performed to determine whether TT position affects the rate of secondary intervention. Patients and Method: We studied adult trauma patients who underwent TT placement over a period of one year (from March 2017 to March 2018) in 3 Nigerian teaching hospitals. Classification of tube placement by radiologist was considered as ideal when the tube was apically directed and placed in the pleural cavity. Non-ideal TT was defined within the fissure or supradiaphragmatic position. The primary outcome was defined as TT replacement, additional TT tube insertion, or surgical intervention. Results: Ninety seven chest trauma patients who underwent TT placement. Indications for placement were HPTx (43.2%), HTx (26.8%), and PTx (30.0%). Majority of patients were male (66%), median age of 40.8 years (IQR 16–55 years), and blunt (71.1%) trauma. Ideal TT positioning was found in 76 (78.4%) and non-ideal 21 (21.6%). Secondary intervention rate was 4 (19.0%) including 3 (14.25%) replaced TT and 1 (4.75%) thoracotomy. Rate of secondary intervention for ideal and non-ideal TT position was 1 (1.0%) and 19.0% (P = 0.009), respectively. The difference in rate of secondary intervention was not significant (25.1% vs 34.1%, P = 0.09). Conclusion: Position of a non-kinked TT with the sentinel hole within the thoracic cavity does not affect secondary intervention rates. Given over 20% of individuals with additional TT placement required operative intervention for definitive management, early operative intervention in the setting of non-kinked TT provides ideal patient care.

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