Percutaneous pigtail catheter versus chest tube for the treatment of pediatric traumatic hemothorax: An Eastern Association for the Surgery of Trauma multicenter study
Laura F Goodman 1, 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 Notrica, 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.
Intended audience: Healthcare professionals and clinicians.
A pediatric trauma patient comes in with hemothorax needing drainage. What tube are you going to use, a chest tube or a pigtail catheter? I'm Jill Westaker, an MD, and this is an article you should know about. Earlier this year, Goodman et al. published an article in the Journal of Trauma and Acute Care Surgery investigating over 500 pediatric trauma patients with hemothorax who were treated with either a pigtail catheter or a chest tube. So what did these authors find? First of all, most patients were treated with a chest tube. Only about 13% were treated with a pigtail. On this though, they didn't find much difference between each group. There was no difference in injury severity score or age between the groups. Length of stay and ICU length of stay also were similar, and importantly, they found no significant difference between tube failure rates or complications between both groups. So what is this article telling us? Overall, pigtail catheters are similarly safe and effective compared to chest tubes. So now that we've reviewed this article, what tube are you going to use?
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