Management of simple and retained hemothorax: A practice management guideline from the Eastern Association for the Surgery of Trauma

Patel, Neel; Dultz, Linda A.; Ladhani, Husayn A; Cullinane, Daniel C.; Klein, Eric E.; McNickle, Allison G.; Bugaev, Nikolay; Fraser, Douglas R.; Kartiko, Susan; Dodgion, Christopher; Pappas, Peter A.; Kim, Dennis; Cantrell, Sarah; Como, John J.; Kasotakis, George

doi:10.1016/j.amjsurg.2020.11.032

Cited by 46 publications

(51 citation statements)

References 22 publications

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“…If these catheters are to be used, we firmly believe that image guidance should be a routine adjunct. This is in line with current EAST recommendations 3 . In patients who are completely stable, one could go so far as to argue in favor of involving interventional radiology, where these services are available.…”

supporting

confidence: 80%

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Letter to the editor: The small (14 Fr) percutaneous catheter (P-CAT) versus large (28–32 Fr) open chest tube for traumatic hemothorax: A multicenter randomized clinical trial

Hylands

Gomez

Beckett

2022

J Trauma Acute Care Surg

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supporting

confidence: 80%

“…This is in line with current EAST recommendations. 3 In patients who are completely stable, one could…”

mentioning

confidence: 99%

Letter to the editor: The small (14 Fr) percutaneous catheter (P-CAT) versus large (28–32 Fr) open chest tube for traumatic hemothorax: A multicenter randomized clinical trial

Hylands

Gomez

Beckett

2022

J Trauma Acute Care Surg

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“…Intrapleural fibrinolytic administration, such as tissue plasminogen activator (tPA), is recommended second line in patients at high risk of surgical complications. 2,5 Intrapleural fibrinolytics (eg, urokinase, streptokinase, alteplase) work by activating plasminogen to plasmin that degrades thrombin facilitating hemothorax drainage. 1,3 However, current data are either retrospective or heterogeneous, leading to the need to find optimal dose, frequency, dwell time, and duration of therapy.…”

Section: Introductionmentioning

confidence: 99%

Retrospective Evaluation of Intrapleural Tissue Plasminogen Activator With or Without Dornase Alfa for the Treatment of Traumatic Retained Hemothorax: A 6-Year Experience

et al. 2022

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Background: Intrapleural fibrinolytic instillation is second-line treatment for retained hemothorax. Dornase alfa (DNase) has demonstrated efficacy in parapneumonic effusion, but the lack of deoxyribonucleoproteins limits direct extrapolation to traumatic retained hemothorax treatment. Objective: This study evaluated the effectiveness of intrapleural tissue plasminogen activator (tPA) with and without DNase in the treatment of retained traumatic hemothorax. Methods: This retrospective cohort study included patients aged 16 years and older admitted to a level 1 trauma center from January 2013 through July 2019 with retained hemothorax and one or more intrapleural tPA instillations. Exclusion criteria were tPA for other indications or concomitant empyema. The primary endpoint was treatment failure defined as the need for operative intervention. Results: Fifty patients were included (tPA alone: 28; tPA with DNase: 22). Baseline characteristics were similar between groups, including time to diagnosis (6.5 [interquartile range (IQR), 4-15.5] days vs 6 [IQR, 6.3-10.8] days, P = 0.52). Median tPA dose per treatment (6 [IQR, 6-6.4] mg vs 10 [IQR, 8.4-10] mg, P < 0.001) and cumulative tPA (18 [IQR, 6.5-24] mg vs 30 [IQR, 29.5-40], P < 0.001) dose were significantly lower in the tPA alone group. Treatment failure was similar between groups. Chest tube output, retained hemothorax reduction, and bleeding incidences were similar between groups. Multivariate logistic regression demonstrated no significant risk factors for treatment failure. Conclusions and Relevance: Dornase alfa added to tPA may not reduce the need for operation to treat retained hemothorax. Further studies should be directed at optimal tPA dose determination and economic impact of inappropriate DNase use.

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“…11 Additional pleural complexity features, such as hyperdense fluid, pleural thickening, gas, and loculation, are used to differentiate between serous and these more complex effusion subtypes [12][13][14] (from now on referred to as simple and complex effusions, respectively). This differentiation has implications for patient management [15][16][17] and outcome, 18,19 whereas machine learning models could also be used for CT-guided planning and fast detection of associated periprocedural pneumothorax and hemothorax. 20,21…”

mentioning

confidence: 99%

Automated Detection, Segmentation, and Classification of Pleural Effusion From Computed Tomography Scans Using Machine Learning

et al. 2022

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ObjectiveThis study trained and evaluated algorithms to detect, segment, and classify simple and complex pleural effusions on computed tomography (CT) scans.Materials and MethodsFor detection and segmentation, we randomly selected 160 chest CT scans out of all consecutive patients (January 2016–January 2021, n = 2659) with reported pleural effusion. Effusions were manually segmented and a negative cohort of chest CTs from 160 patients without effusions was added. A deep convolutional neural network (nnU-Net) was trained and cross-validated (n = 224; 70%) for segmentation and tested on a separate subset (n = 96; 30%) with the same distribution of reported pleural complexity features as in the training cohort (eg, hyperdense fluid, gas, pleural thickening and loculation). On a separate consecutive cohort with a high prevalence of pleural complexity features (n = 335), a random forest model was implemented for classification of segmented effusions with Hounsfield unit thresholds, density distribution, and radiomics-based features as input. As performance measures, sensitivity, specificity, and area under the curves (AUCs) for detection/classifier evaluation (per-case level) and Dice coefficient and volume analysis for the segmentation task were used.ResultsSensitivity and specificity for detection of effusion were excellent at 0.99 and 0.98, respectively (n = 96; AUC, 0.996, test data). Segmentation was robust (median Dice, 0.89; median absolute volume difference, 13 mL), irrespective of size, complexity, or contrast phase. The sensitivity, specificity, and AUC for classification in simple versus complex effusions were 0.67, 0.75, and 0.77, respectively.ConclusionUsing a dataset with different degrees of complexity, a robust model was developed for the detection, segmentation, and classification of effusion subtypes. The algorithms are openly available at https://github.com/usb-radiology/pleuraleffusion.git.

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Management of simple and retained hemothorax: A practice management guideline from the Eastern Association for the Surgery of Trauma

Cited by 46 publications

References 22 publications

Letter to the editor: The small (14 Fr) percutaneous catheter (P-CAT) versus large (28–32 Fr) open chest tube for traumatic hemothorax: A multicenter randomized clinical trial

Letter to the editor: The small (14 Fr) percutaneous catheter (P-CAT) versus large (28–32 Fr) open chest tube for traumatic hemothorax: A multicenter randomized clinical trial

Retrospective Evaluation of Intrapleural Tissue Plasminogen Activator With or Without Dornase Alfa for the Treatment of Traumatic Retained Hemothorax: A 6-Year Experience

Automated Detection, Segmentation, and Classification of Pleural Effusion From Computed Tomography Scans Using Machine Learning

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