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Negin Mohtashemian B.S1., Antonela Muca M.D.2, Katelyn Ward M.D.2, Kimberly Aung M.D.2, Michael Tolkacz, M.D.2, Rose Callahan M.S.3, Jacob Keeley M.S.1, Diane Studzinski M.S.3, Anthony Iacco M.D.2

1Bachelor of Science, Oakland University William Beaumont School of Medicine

2Corewell Health William beaumont University Hospital

3Masters of Science, CorewellHealth William Beaumont University Hospital

Association Between Chest Tube Size and Complication Rates in Trauma Patients

Introduction

Aims and Objectives

Methods

Results

References

Acknowledgements

Conclusions

  • Chest tubes are among the most commonly performed hospital procedures to evacuate/monitor hemothorax, prevent tension pneumothorax, re-expand the lung, and relieve pressure in the pleural space.
  • Common indications: trauma and postoperative needs or other causes of pleural air/fluid accumulation (e.g., malignancy).
  • Risks of injury and infection due to the proximity of vital structures: lung, heart, diaphragm, phrenic nerve, thoracic duct, major vessels.
  • Complication rates may be influenced more by tube size and insertion technique than by the exact placement location.

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  • Goal: Evaluate how chest tube size, in the context of trauma injury severity, affects complication rates (infection, LOS/ICU stay, bleeding, organ injury, need for additional tubes).
  • Prior research exists, but often examines only limited variables, uses models instead of patient data, or does not account for how injury severity influences tube size selection.
  • This project focuses on a specific component of a larger retrospective study on chest tube complications in trauma patients at Corewell Health Royal Oak.

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  • Retrospective study at CHWBUH using trauma patients ≥18 years old from Jan 1, 2011–Dec 1, 2022.
  • Data sources: ACS TQIP, Royal Oak trauma database and Epic EMR
  • Variables: Revised Trauma Score, comorbidities, mechanism of injury, provider training level, hospital length of stay, and complications.
  • Analysis supported by an OUWB Research Institute biostatistician.
  • Patients divided into two main groups:
  • Single chest tube
  • Multiple chest tubes
  • Single-tube group further subdivided by tube size Multi-tube group analyzed separately for complication patterns.

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1. Stawicki StanislawPA, Kwiatt M, Tarbox A, et al. Thoracostomy tubes: A comprehensive review of complications and related topics. International Journal of Critical Illness and Injury Science. 2014;4(2):142.

2. Revised Trauma Score. MDCalc. Accessed June 5, 2023. https://www.mdcalc.com/calc/683/revised-trauma-score�3. Moran ME, Nash JE. Revised Trauma Scale. PubMed. Published 2022. https://www.ncbi.nlm.nih.gov/books/NBK556036/

4. Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME. A Revision of the Trauma Score. Journal of Trauma and Acute Care Surgery. 1989;29(5):623-629. Accessed July 22, 2022. https://journals.lww.com/jtrauma/abstract/1989/05000/a_revision_of_the_trauma_score.17.aspx

5. Jeong JH, Park YJ, Kim DH, et al. The new trauma score (NTS): a modification of the revised trauma score for better trauma mortality prediction. BMC Surgery. 2017;17(1).

6. Menger R, Telford G, Kim P, et al. Complications following thoracic trauma managed with tube thoracostomy. Injury. 2012;43(1):46-50. doi:https://doi.org/10.1016/j.injury.2011.06.420

7. Chen RB, Hu H, Matro E. Transcatheter arterial embolization for intercostal arterial bleeding in a patient after chest tube insertion. journal of thoracic disease . 2015;7(7):E194-7.

8. Coulter TD, Maurer JR, Miller MT, Mehta AC. Chest wall arteriovenous fistula: an unusual complication after chest tube placement. The Annals of Thoracic Surgery. 1999;67(3):849-850.

9. Benns MV, Egger ME, Harbrecht BG, et al. Does chest tube location matter? An analysis of chest tube position and the need for secondary interventions. Journal of Trauma and Acute Care Surgery. 2015;78(2):386-390.

10. Rishi. Catheter Sizing - French Versus Gauge. RK.MD. Published June 6, 2018. Accessed June 5, 2023. https://rk.md/2018/catheter-sizing-french-versus-gauge/

Oakland University William Beaumont School of Medicine

Corewell Health William Beaumont University Hospital

MQTIP Database

American College of Surgery

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Figure 1: Study Population Demographics.

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Figure 2: Complications Associated with Chest Tube Size in Trauma Patients

Figure 3: Summary of Complications Associated with Chest Tube Size (Fr)

  • Smallest tubes were placed primarily in older patients with more comorbidities, lower trauma severity, and elective or semi-urgent indications.
  • Medium tubes were used most often for rib fractures and moderate trauma severity.
  • Largest tubes were placed in younger patients with higher trauma severity, hemothorax, and emergent indications, often associated with longer hospital stays and increased ventilator dependence.
  • Complications were rare across all tube sizes, though larger tubes showed a slightly higher need for additional tubes and ventilator support.

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