The management of traumatic haemothorax and haemopneumothorax by closed tube thoracostomy as practised in Kenyatta National Hospital

Abstract

This is a prospective study conducted between tenth of February and tenth of ovember 2004. A total of ninety-five patients with posttraumatic pleural collections with pncumothoraxancl/ or haemothorax were recruited. Ninety-six chest tubes were inserted in ninety-two patients. I~ighty-eight had unilateral chest tubes while the remaining 4 had bilateral chest tubes. Three patients were managed conservatively. Eighty seven percent of the patients were males and nearly 70% were in the 20-40 yearsage bracket. It was found that patients in slum areas were at higher risk for penetrating injuries compared to non-slum dwellers. SixtY'one percent of the patients I presented with penetrating injuries the majority of which were as a result of stab wounds. Two thirds of blunt injuries were due to RTA. Nearly all the patients had chest radiographs performed prior to insertion of a chest tube. The commonest pleural collection was haemopneumothorax(48.4%), which if combined with simple haemothorax account for 72.6%. Only three different sizes of chest tubes were utilizeJ-FG20, 24, 28-with PG-28 been the commonest tube used (57%).All tube insertions were carried out in the triangle of safety with the fifth intercostal space used in 52% of the patients. Sixty patients (62.5%) had their chest tube removed within one week. Only six patients had their tubes maintained for fifteen days or more. Two-third of patients with hacmothorax had an output of 750mls or less in the first twenty-four hours. The study showed that 54% of the patients had their tubes removed on the basis of chest radiographs. There was no significant difference on the outcome between the patients who had their tubes removed on the basis of clinical examination or chest radiographs. Thecommonest complication encountered was empyema thoracis (8.4%). Empyema was highlyassociated with knife stabs and longer period of chest tube left in situ. Mortalitywas due to the initial injury and was commoner among patients withRTA andgunshot injuries,