Clinical Outcomes of Children with Traumatic Hemothorax Treated with Non-Operative Management, Video-Assisted Thoracoscopic Surgery, or Thoracotomy
Heather M. Grant1,2, Alexander Knee3,4, Michael V. Tirabassi1,5
1Department of Surgery, UMass Medical School – Baystate, Springfield, MA 2Institute for Healthcare Delivery and Population Science, UMass Medical School – Baystate, Springfield, MA 3Office of Research, Epidemiology/Biostatistics Research Core, Baystate Medical Center, Springfield, MA 4Department of Medicine, UMass Medical School – Baystate, Springfield, MA 5Baystate Children’s Hospital, Springfield, MA
Background: Due to the relative rarity of traumatic hemothorax in children, few studies have compared the outcomes of non-operative management compared to early VATS, late VATS, and thoracotomy.
Methods: We included all patients 48-hours), and thoracotomy.
Results: 9105 patients met inclusion criteria. Across both trauma types, the majority of patients were managed non-operatively and those who underwent thoracotomy had the lowest initial GCS, the highest ISS, and the most reinterventions. Among penetrating traumas, conversion to open was more common with early VATS, but time to discharge was similar to non-operative management; however, patients who underwent late VATS or thoracotomy were significantly less likely to be discharged at any point in time. Additionally, the early VATS group had the fewest ICU and ventilator days. Among blunt injuries, the likelihood of discharge at any time was similar for early and late VATS compared to non-operative management, but there was a significantly lower rate of discharge for patients who underwent thoracotomy. Conclusions: We should likely be cautious in our use of VATS for children with traumatic hemothorax, as non-operative management appears to be successful in the majority of patients. If operative intervention is required, VATS within 48-hours of admission may reduce hospital LOS for both blunt and penetrating injuries, as well as ICU LOS and DMV for blunt injuries.
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