Pre-hospital and in-hospital thoracostomy: indications and complications

Ann R Coll Surg Engl. 2008 Jan;90(1):54-7. doi: 10.1308/003588408X242286.


Introduction: Pleural drainage with chest tube insertion for thoracic trauma is a common and often life-saving technique. Although considered a simple procedure, complication rates have been reported to be 2-25%. We conducted a prospective cohort observational study of emergency pleural drainage procedures to validate the indications for pre-hospital thoracostomy and to identify complications from both pre- and in-hospital thoracostomies.

Patients and methods: Data were collected over a 7-month period on all patients receiving either pre-hospital thoracostomy or emergency department tube thoracostomy. Outcome measures were appropriate indications, errors in tube placement and subsequent complications.

Results: Ninety-one chest tubes were placed into 52 patients. Sixty-five thoracostomies were performed in the field without chest tube placement. Twenty-six procedures were performed following emergency department identification of thoracic injury. Of the 65 pre-hospital thoracostomies, 40 (61%) were for appropriate indications of suspected tension pneumothorax or a low output state. The overall complication rate was 14% of which 9% were classified as major and three patients required surgical intervention. Twenty-eight (31%) chest tubes were poorly positioned and 15 (17%) of these required repositioning.

Conclusions: Pleural drainage techniques may be complicated and have the potential to cause life-threatening injury. Pre-hospital thoracostomies have the same potential risks as in-hospital procedures and attention must be paid to insertion techniques under difficult scene conditions. In-hospital chest tube placement complication rates remain uncomfortably high, and attention must be placed on training and assessment of staff in this basic procedure.

MeSH terms

  • Adult
  • Chest Tubes / statistics & numerical data
  • Cohort Studies
  • Drainage / instrumentation
  • Drainage / methods
  • Emergency Medical Services / statistics & numerical data
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Hemothorax / surgery
  • Humans
  • London
  • Male
  • Pneumothorax / surgery
  • Prospective Studies
  • Thoracic Injuries / surgery*
  • Thoracostomy / adverse effects
  • Thoracostomy / methods*