Re-evaluation of the Impact of Chest Tube Size in Pediatric Trauma
Colin Muncie, Chinwendu Onwubiko, Marco Aru, *Matthew E Kutcher, Barry R Berch
University of Mississippi Medical Center, Jackson, MS
Purpose: Chest tube size in injured adults does not impact outcomes. However, optimal tube size in injured children is poorly defined. We examined the practice and impact of chest tube size in pediatric trauma.
Methods: Patients aged 0-16 undergoing non-pigtail thoracostomy for traumatic hemo/pneumothorax from 6/2007-6/2016 at a Level One trauma center were retrospectively reviewed. Patients with immediate thoracotomy or death before tube removal were excluded. Complications included recurrent pneumothorax, retained hemothorax, pneumonia, and empyema. Intercostal height was measured on sagittal CT imaging.
Results: Of 98 chest tubes in 90 patients (45% pneumothorax, 55% hemothorax), mean size was 26±7.9 French. Tube size correlated with 24-hour and total drainage (p<0.012). 30% of patients had a complication; of these, repositioning (10%), additional tube placement (14%), and thoracoscopy (5%) were required. 36% of chest tubes were oversized by age criteria, and 50% had an outer diameter larger than measured intercostal height. Oversizing was associated with larger tube size (p=0.003), increased drainage (p<0.034), and prolonged hospital stay (p=0.023). Univariate predictors of complications included weight (p=0.033), body mass index (0.044), and pulmonary contusion (p=0.027); only pulmonary contusion (odds ratio 3.33, p=0.016) remained significant in multivariate analysis. Neither chest tube size nor oversizing were associated with complications.
Conclusions: Chest tube oversizing is strikingly common in injured children, and is associated with increased drainage and hospital stay, but not with fewer complications. Chest tube size recommendations for injured children should be re-evaluated.
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