Early thoracoscopy for the evacuation of undrained haemothorax

Abstract

Objective: To evaluate the accuracy of radiological tests and the outcome after thoracoscopic evacuation of retained haemothorax. Design: Prospective study. Setting: Academic trauma centre, USA. Subjects: Of 703 patients with thoracic injuries, 58 (8%) were evaluated for and 15 (2%) were found to have, retained haemothorax. Interventions: Plain chest radiographs (CXR) and thoracic computed tomograms (CT) 48 hours after admission, and thoracoscopic evacuation within 3-6 days of admission. Main outcome measures: Accuracy of radiological tests, morbidity, and mortality. Results: 12 patients underwent early thoracoscopy with minimal morbidity, no mortality, and appreciable clinical and radiological improvement. Three patients who were not operated on developed empyemas. CXR was inaccurate in predicting the need for thoracoscopy. CT was the only test that predicted the need for evacuation of haemothoraces. Conclusion: Thoracoscopic evacuation of retained haemothorax is safe and effective. The success of the procedure is assured by early intervention in appropriately selected patients. CT is the ultimate test on which to base decision-making.