1086 Improving the Use of Chest Drains in Trauma - Small but Perfectly Formed

Aim

The Western Trauma Association (WTA) advocates using small-bore chest drains (e.g., 14Fr) in haemodynamically normal trauma patients for management of small Haemothoraxes (HTX) or Pneumothoraxes (PTX). This quality improvement project aimed to assess implementation of this guidance.

Method

We compared the use and outcomes of small-bore chest drains for management of HTX or PTX before (Cohort 1) and after (Cohort 2) adoption of WTA recommendations in a District General Hospital in London. We included all patients admitted under the General Surgeons with rib fractures.

Results

All patients were admitted with blunt chest injuries. Cohort 1: 60 patients [36 males, mean age 72 years (range 31-96)] admitted from May–December 2021. Cohort 2: 78 patients [42 males, mean age 73 years (range 23-102)] admitted from May–December 2022.

In cohort 1, 10 patients (16%) required chest drains, all were surgically inserted large bore drains (median size 28 Fr) there were no peri-procedural complications.

In cohort 2, 11 patients (14%) required chest drains; 5 were surgically placed large bore drains (median size 28 Fr) and 6 were small-bore drains inserted by Seldinger technique (median size 18Fr). Two large-bore drains had periprocedural complications and both required re-insertion. The mean age was 60 years. In the small-bore group, there were no peri-procedural complications, no drains occluded and the mean age was 75 years.

Conclusions

After the implementation of this policy, small-bore drain use increased and appeared safe. This audit supports recent literature suggesting small-bore drains are as effective as larger bore and better tolerated.