Impact of Preceding Chest CT on Functional Malpositioning of Chest Tubes in Traumatic Pneumothorax and Hemopneumothorax

Abstract

Background

It remains controversial whether the lateral or the anterior approach is optimal for chest tube insertion in patients with traumatic pneumothorax (PTH).

Objectives

This study aimed to evaluate the incidence of functional malpositioning of chest tubes inserted via the lateral versus anterior approach in patients with traumatic pneumothorax (PTH) and/or hemopneumothorax (HPTH), with or without a preceding CT examination.

Methods

We conducted a two-center, retrospective, observational study of consecutive patients treated with a chest tube for traumatic PTH/HPTH between August 2012 and September 2021. Patients were divided into two groups according to the presence or absence of CT examination before chest tube insertion: CT(+) or CT(−) group. In each group, the risk of functional malpositioning was compared between the lateral and anterior approaches.

Results

Among 388 patients, 271 patients were analyzed. The CT(+) group comprised 200 (74%) patients, while the CT(−) group comprised 71 (26%) patients. The adjusted odds ratio of functional malpositioning with the lateral approach was 1.38 (95% confidence interval 0.64–2.98, p = 0.41) in the CT(+) group and 9.24 (95% confidence interval 1.49–57.50, p < 0.01) in the CT(−) group. There was a trend suggesting that the risk of functional malposition of chest tubes associated with the lateral approach, compared with the anterior approach, was modified by the presence or absence of a preceding CT examination (p_interaction = 0.01).

Conclusions

The occurrence of functional malpositioning of the chest tube in patients with traumatic PTH/HPTH was higher with the lateral approach in patients without a preceding CT examination.