An audit of the complications of intercostal chest drain insertion in a high volume trauma service in South Africa

• Published in: Annals of the Royal College of Surgeons of England 2014-11, Vol.96 (8), p.609-613
• Main Authors: Kong, V Y, Oosthuizen, G V, Sartorius, B, Keene, C, Clarke, D L
• Format: Article
• Language: English
• Subjects: Adult; Assaults; Chest Tubes - adverse effects; Humans; Injuries; Male; Medical Audit; Patient safety; Physicians; Pneumothorax - epidemiology; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Pulmonary arteries; Retrospective Studies; South Africa - epidemiology; Thoracic Surgery; Thoracostomy - adverse effects; Thoracostomy - instrumentation; Trauma; Trauma centers; Trauma Centers - statistics & numerical data; Veins & arteries; Wounds, Penetrating - epidemiology; Wounds, Penetrating - surgery; Young Adult
• ISSN: 0035-8843; 1478-7083
• DOI: 10.1308/003588414X14055925058599

Intercostal chest drain (ICD) insertion is a commonly performed procedure in trauma and may be associated with significant morbidity. 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. 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). 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