An audit of the complications of intercostal chest drain insertion in a high volume trauma service in South Africa
<p><strong>Introduction</strong></p> Intercostal chest drain (ICD) insertion is a commonly performed procedure in trauma and may be associated with significant morbidity. <p><strong>Methods</strong></p> This was a retrospective review of ICD complicati...
| Main Authors: | , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
Royal College of Surgeons of England
2015
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| _version_ | 1826311439648817152 |
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| author | Kong, VY Oosthuizen, GV Sartorius, B Keene, C Clarke, DL |
| author_facet | Kong, VY Oosthuizen, GV Sartorius, B Keene, C Clarke, DL |
| author_sort | Kong, VY |
| collection | OXFORD |
| description | <p><strong>Introduction</strong></p>
Intercostal chest drain (ICD) insertion is a commonly performed procedure in trauma and may be associated with significant morbidity.
<p><strong>Methods</strong></p>
This was a retrospective review of ICD complications in a major trauma service in South Africa over a four-year period from January 2010 to December 2013.
<p><strong>Results</strong></p>
A total of 1,050 ICDs were inserted in 1,006 patients, of which 91% were male. The median patient age was 24 years (interquartile range [IQR]: 20–29 years). There were 962 patients with unilateral ICDs and 44 with bilateral ICDs. Seventy-five per cent (758/1,006) sustained penetrating trauma and the remaining 25% (248/1006) sustained blunt trauma. Indications for ICD insertion were: haemopneumothorax (n=338), haemothorax (n=314), simple pneumothorax (n=265), tension pneumothorax (n=79) and open pneumothorax (n=54).
<br>
Overall, 203 ICDs (19%) were associated with complications: 18% (36/203) were kinked, 18% (36/203) were inserted subcutaneously, 13% (27/203) were too shallow and in 7% (14/203) there was inadequate fixation resulting in dislodgement. Four patients (2%) sustained visceral injuries and two sustained vascular injuries. Forty-one per cent (83/203) were inserted outside the ‘triangle of safety’ but without visceral or vascular injuries. One patient had the ICD inserted on the wrong side. Junior doctors inserted 798 ICDs (76%) while senior doctors inserted 252 (24%). Junior doctors had a significantly higher complication rate (24%) compared with senior doctors (5%) (p<0.001). There was no mortality as a direct result of ICD insertion.
<p><strong>Conclusions</strong></p>
ICD insertion is associated with a high rate of complications. These complications are significantly higher when junior doctors perform the procedure. A multifaceted quality improvement programme is needed to improve the situation. |
| first_indexed | 2024-03-07T08:08:26Z |
| format | Journal article |
| id | oxford-uuid:a4c40598-ca06-46f3-bcec-5119ea992ab5 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T08:08:26Z |
| publishDate | 2015 |
| publisher | Royal College of Surgeons of England |
| record_format | dspace |
| spelling | oxford-uuid:a4c40598-ca06-46f3-bcec-5119ea992ab52023-11-13T15:04:58ZAn audit of the complications of intercostal chest drain insertion in a high volume trauma service in South AfricaJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:a4c40598-ca06-46f3-bcec-5119ea992ab5EnglishSymplectic ElementsRoyal College of Surgeons of England2015Kong, VYOosthuizen, GVSartorius, BKeene, CClarke, DL<p><strong>Introduction</strong></p> Intercostal chest drain (ICD) insertion is a commonly performed procedure in trauma and may be associated with significant morbidity. <p><strong>Methods</strong></p> This was a retrospective review of ICD complications in a major trauma service in South Africa over a four-year period from January 2010 to December 2013. <p><strong>Results</strong></p> A total of 1,050 ICDs were inserted in 1,006 patients, of which 91% were male. The median patient age was 24 years (interquartile range [IQR]: 20–29 years). There were 962 patients with unilateral ICDs and 44 with bilateral ICDs. Seventy-five per cent (758/1,006) sustained penetrating trauma and the remaining 25% (248/1006) sustained blunt trauma. Indications for ICD insertion were: haemopneumothorax (n=338), haemothorax (n=314), simple pneumothorax (n=265), tension pneumothorax (n=79) and open pneumothorax (n=54). <br> Overall, 203 ICDs (19%) were associated with complications: 18% (36/203) were kinked, 18% (36/203) were inserted subcutaneously, 13% (27/203) were too shallow and in 7% (14/203) there was inadequate fixation resulting in dislodgement. Four patients (2%) sustained visceral injuries and two sustained vascular injuries. Forty-one per cent (83/203) were inserted outside the ‘triangle of safety’ but without visceral or vascular injuries. One patient had the ICD inserted on the wrong side. Junior doctors inserted 798 ICDs (76%) while senior doctors inserted 252 (24%). Junior doctors had a significantly higher complication rate (24%) compared with senior doctors (5%) (p<0.001). There was no mortality as a direct result of ICD insertion. <p><strong>Conclusions</strong></p> ICD insertion is associated with a high rate of complications. These complications are significantly higher when junior doctors perform the procedure. A multifaceted quality improvement programme is needed to improve the situation. |
| spellingShingle | Kong, VY Oosthuizen, GV Sartorius, B Keene, C Clarke, DL An audit of the complications of intercostal chest drain insertion in a high volume trauma service in South Africa |
| title | An audit of the complications of intercostal chest drain insertion in a high volume trauma service in South Africa |
| title_full | An audit of the complications of intercostal chest drain insertion in a high volume trauma service in South Africa |
| title_fullStr | An audit of the complications of intercostal chest drain insertion in a high volume trauma service in South Africa |
| title_full_unstemmed | An audit of the complications of intercostal chest drain insertion in a high volume trauma service in South Africa |
| title_short | An audit of the complications of intercostal chest drain insertion in a high volume trauma service in South Africa |
| title_sort | audit of the complications of intercostal chest drain insertion in a high volume trauma service in south africa |
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