Chest Tube Management Practices by Trauma Surgeons

• Published in: The Journal of surgical research Vol. 244; pp. 225 - 230
• Main Authors: Parker, Michael H., Newcomb, Anna B., Liu, Chang, Michetti, Christopher P.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2019
• Subjects: Adult; Age Factors; Aged; Chest tube; Chest tube management; Chest Tubes - statistics & numerical data; Clinical Competence - statistics & numerical data; Hemothorax; Hemothorax - etiology; Hemothorax - surgery; Humans; Pneumothorax; Pneumothorax - etiology; Pneumothorax - surgery; Practice Patterns, Physicians' - standards; Practice Patterns, Physicians' - statistics & numerical data; Surgeons - statistics & numerical data; Survey; Surveys and Questionnaires - statistics & numerical data; Thoracostomy - instrumentation; Thoracostomy - standards; Thoracostomy - statistics & numerical data; Trauma; Wounds and Injuries - complications; Wounds and Injuries - surgery; Chest tube management; Survey; Pneumothorax; Trauma; Hemothorax; Chest tube
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2019.06.032

Chest tube (CT) placement is among the most common procedures performed by trauma surgeons; evidence guiding CT management is limited and tends toward thoracic surgery patients. The study goal was to identify current CT management practices among trauma providers. We designed a Web-based multiple-choice survey to assess CT management practices of trauma providers who were active, senior, or provisional members (n = 1890) of the Eastern Association for the Surgery of Trauma and distributed via e-mail. Descriptive statistics were used. The response rate was 39% (n = 734). Ninety-one percent of respondents were attending surgeons, the remainder fellows or residents. Regarding experience, 36% of respondents had five or fewer years of practice, 54% 10 y or fewer, and 79% 20 y or fewer. Attendings were more likely than trainees to place pigtail catheters for stable patients with pneumothorax (PTX). Attendings with experience of <5 y were more likely to choose a pigtail than more experienced surgeons for elderly patients with PTX. Respondents preferred standard size CTs for hemothorax and unstable patients with PTX, and larger tubes for unstable patients with hemothorax. Most respondents (53%) perceived the quality of evidence for trauma CT management to be low and cited personal experience and training as the main factors driving their practice. Trauma CT management is variable and nonstandardized, depending mostly on clinician training and personal experience. Few surgeons identify their practice as evidence based. We offer compelling justification for the need for trauma CT management research to determine best practices.