Introduction Tube thoracostomy (TT), considered a routine procedure, has significant complications. Current recommendations for placement rely on surface anatomy. There is no information to guide operators regarding angle of insertion relative to chest wall. We aim to determine if angle of insertion is associated with complications of TT. Methods We performed a retrospective review of adult trauma patients who necessitated TT at a level I trauma center over a 2 year period (January 2012 – December 2013). TT performed intraoperatively or using radiological guidance were excluded. Thoracic anteroposterior (AP) or posteroanterior (PA) radiographs were reviewed to determine the angle of insertion of TT relative to the thoracic wall. A previously validated classification method was utilized to categorize complications. Descriptive and univariate statistics were used to compare angle of insertion and complicated vs uncomplicated TT. Results Review identified 154 patients who underwent a total of 246 TT placed for emergent trauma. All patients had a post-procedural chest x-ray. We identified 90 complications (37%) over the study period. 144 of the TT’s reviewed had an angle of insertion less than 45 degrees of which there were 27 complications (19%). 102 of the TT’s had an angle greater than 45 degrees and 63 complications (62%), P<0.0001. Conclusions Tube thoracostomy insertion is inherently dangerous. Placement of TT using a higher angle of insertion greater than 45 degrees is associated with increased complications. Further prospective studies quantifying TT angle of insertion on outcomes are needed. Level of Evidence Level IV therapeutic study.
interests in biomechanics include developing clinical instruments for rehabilitation. Dr. DeGoede teaches upper-level undergraduate mechanical engineering and design courses and the first-year introduction to engineering course. He is also developing a collaborative study abroad program in West Africa built around social enterprise initiatives.
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