Chest Tube Management Practices by Trauma Surgeons.

Abstract

BACKGROUND\nChest tube (CT) placement is among the most common procedures performed by trauma surgeons; evidence guiding CT management is limited and tends toward thoracic surgery patients. The study goal was to identify current CT management practices among trauma providers.\n\n\nMATERIALS AND METHODS\nWe designed a Web-based multiple-choice survey to assess CT management practices of trauma providers who were active, senior, or provisional members (n\xa0=\xa01890) of the Eastern Association for the Surgery of Trauma and distributed via e-mail. Descriptive statistics were used.\n\n\nRESULTS\nThe response rate was 39% (n\xa0=\xa0734). Ninety-one percent of respondents were attending surgeons, the remainder fellows or residents. Regarding experience, 36% of respondents had five or fewer years of practice, 54% 10\xa0y or fewer, and 79% 20\xa0y or fewer. Attendings were more likely than trainees to place pigtail catheters for stable patients with pneumothorax (PTX). Attendings with experience of <5\xa0y were more likely to choose a pigtail than more experienced surgeons for elderly patients with PTX. Respondents preferred standard size CTs for hemothorax and unstable patients with PTX, and larger tubes for unstable patients with hemothorax. Most respondents (53%) perceived the quality of evidence for trauma CT management to be low and cited personal experience and training as the main factors driving their practice.\n\n\nCONCLUSIONS\nTrauma CT management is variable and nonstandardized, depending mostly on clinician training and personal experience. Few surgeons identify their practice as evidence based. We offer compelling justification for the need for trauma CT management research to determine best practices.