Percutaneous pigtail catheter versus chest tube for the treatment of pediatric traumatic hemothorax

Infographic · Nov 2025 · 2 min read

In brief

Multi-center retrospective study of 548 pediatric trauma patients compared pigtail catheters to traditional chest tubes for hemothorax treatment. Both approaches showed similar failure rates (12.6% vs 17.6%) and complication profiles after adjustment, suggesting pigtail catheters are a safe alternative in hemodynamically stable children.

Pigtail catheters show equivalent failure rates to chest tubes (12.6% vs 17.6%, p=0.38) for pediatric traumatic hemothorax drainage.
After adjusting for confounders, pigtail catheters carry no increased complication risk compared to traditional chest tubes (OR 1.05, p=0.3).
Injury Severity Score >15 increases complication risk (OR 1.17, p<0.0001), while penetrating injuries show lower risk (OR 0.86, p=0.0001).
Pigtail catheters offer a less invasive alternative to chest tubes without compromising safety or efficacy in stable pediatric trauma patients.
Multi-center data (548 patients, 41 centers) supports pigtail catheter use for hemothorax/hemopneumothorax in children under 18 years.

Written by the GCMD Library team from the infographic.

The infographic uses a teal, pink, and lime green color scheme with three main sections. The left side features an illustration of lungs with arrows indicating fluid drainage. The center shows a healthcare provider holding an x-ray. Key findings are displayed in colored boxes, with the conclusion highlighted in yellow at the bottom.

Laura F Goodman, Alice M Martino, John Schomberg, Jason D Sciarretta, Mari Freedberg, Adora Santos, Sharven Taghavi, Martin Tafazoli, David V Shatz, Kathleen E Doyle, Samantha M Koenig, Robert T Russel, V Christian Sanderfer, Samuel W Ross, Lawrence Willis, Regan F Williams, Meera Kotagal, Stephen J Hartman, Deidre Wyrick, Derek Krinock, Nicholas Namias, Connor Shatz, Ryan Spurrier, MaKayla L O'Guinn, R Scott Eldredge, David N Notricia, Allison G McNickle, Michael Farrell, Elizabeth Hughes, Allison B Frederick, Christian J Streck, Roseanna Guzman-Curtis, Alexandra Dimmer, Isabella Armento, Shea P Gallagher, Matthew J Martin, Oliver B Lao, Kelsey Palladino, Thomas K Duncan, Graal Diaz, Stephanie D Chao, Meagan E Peterson, David Darcy, Matt Byrne, Francesk Mulita, Vasileios Mousafeiris, Arturo Aranda, Rodrigo Gerardo, Daniel C Cullinane, Christopher G Turner, Claudia Alvarez, Sara B Edwards, Raul Coimbra, Lucas P Neff, Jessica L Rauh, Jessica A Keeley, Hye Kwang E Kim, Christopher Fisher, Priya Patel, Victoriya Staab, Charles Lu, Utsav Patwardhan, Romeo C Ignacio, Andrei Radulescu, Georgi Mladenov, Patrick C Bonasso 2nd, Daniel W Regeir, Patricio E Lau, Samantha Troncoso-Munoz, Alana Beres, Stephanie Papillon, Amanda Carlson, Syamal Dave Bhattacharya, Alexander Urevick, Brianna M Holcomb, Shannon L Castle, Umar F Bhatti, Eric J Ley, Peter Ehrlich, Nikhil Shah, Jeffry Nahmias

Background: Small percutaneously placed pigtail catheters (PCs) for traumatic hemothorax (HTX) are safe and effective in adults but have not been evaluated in children. We hypothesized that PC would have similar efficacy and complication rates compared with chest tubes (CTs).

Methods: A retrospective study of hemodynamically stable pediatric trauma patients (younger than 18 years) with HTX or hemopneumothorax was conducted at 41 trauma centers (January 2010 to December 2022). Catheter failure was defined as a requirement for surgery, additional tube placement, or thrombolytics. Multivariable logistic regression analysis adjusting for age, sex, mechanism of injury, and Injury Severity Score (ISS) was used to evaluate the associated risk of failure.

Results: Of 548 patients, 477 had CT and 71 PC. The median age (CT: 15.7 vs. PC: 15.6, p = 0.49) and ISS (CT: 17 vs. PC: 16, p = 0.17) were similar between cohorts. Penetrating trauma patients more often received CTs (62.6% vs. 35.2%, p < 0.0001). Failure rate was similar between CT versus PC (17.6% vs. 12.6%, p = 0.38). While the overall complication rate (respiratory distress, effusion, empyema, pneumonia, infection, deep venous thrombosis) was higher in the PC group on univariate analysis (19.7% vs. 11.9% in CT, p = 0.02), the risk of complications was not increased on multivariable analysis (odds ratio, 1.05; 95% confidence interval, 0.95-1.15; p = 0.3). Length of stay and intensive care unit length of stay were similar between cohorts (all p > 0.05). Logistic regression analysis revealed that PC was not associated with the risk of failure (odds ratio, 0.95; 95% confidence interval, 0.87-1.04; p = 0.31). There was an increased risk of complications with ISS of >15 (odds ratio, 1.17; 95% confidence interval, 1.10-1.26; p < 0.0001) and lower risk with penetrating injury (odds ratio, 0.86; 95%confidence interval, 0.80-0.92; p = 0.0001).

Conclusion: There was no difference in risk of failure between PC and CT for pediatric HTX/hemopneumothorax and no difference in risk of complications after adjustment for confounders. Pigtail catheters had similar safety and efficacy compared with larger-bore CTs in this large multi-institutional study.

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