Computed tomography-detected hemothorax after blunt chest trauma: Does everyone need an intervention? A retrospective analysis

Background: The frequent use of computed tomography (CT) scan in the evaluation of trauma patients has led to an increase in the diagnosis of hemothorax. This study aimed to assess whether a hemothorax volume of <300 ml, as determined by CT imaging, can be managed without tube thoracostomy and to identify the factors that recommend its use. Methods: A retrospective observational study was conducted at XXX Trauma Center, including all patients with traumatic hemothorax from June 2014 to January 2020. Patient demographics, injury mechanism, severity, associated chest injuries, indications for tube thoracostomy, mechanical ventilation, hospital length of stay, complications, and outcomes were reviewed. The study compared patients with hemothorax volumes < 300 ml and ≥300 ml and assessed the outcomes of conservative management without tube thoracostomy (conservative management) vs therapeutic management with tube thoracostomy placement (failed observation). Results: A total of 254 patients with hemothorax were included. Most patients (79 %) were successfully managed without tube thoracostomy insertion, while 53 patients (21 %) required tube thoracostomy after failure of conservative management. Patients with larger hemothorax volumes were significantly more likely to require tube thoracostomy (p = 0.001) and had significantly longer hospital stays (p = 0.021). Those with failed observation had higher injury severity scores (p = 0.001), more associated lung contusions (p = 0.015), pneumothorax (p = 0.024), and rib fractures (p = 0.001). They also had larger hemothorax volumes (p = 0.001), a greater need for mechanical ventilation (p = 0.001), and prolonged hospitalization (p = 0.001). Predictors of failed observation included high hemothorax volume (≥300 ml), ISS, and greater number of fractured ribs. Conclusion: Conservative management (without tube thoracostomy) was adequate for most patients with <300 ml of hemothorax volumes. Quantitative assessment of hemothorax volume should be considered part of the clinical decision-making algorithm. Further research is needed to refine management strategies and improve outcomes for traumatic hemothorax.