Lateral Thoracostomy Tubes: Is Outcome Affected by Level of Intercostal Space?

Objectives: Tube thoracostomy is a common procedure performed after chest trauma. The current practice is to insert the tube in the 3rd, 4th, or 5th intercostal space (ICS) at the anterior axillary line. In this study we compared the outcome of tubes inserted at lower spaces versus the standard (higher) location.Methods: Patients receiving a chest tube after chest trauma were identified using the trauma registry at a Level 1 trauma center from July 2009 to December 2011. Each tube inserted was categorized as either “High” (3rd-5th ICS) or “Low” (6th-7th ICS) placement. Patient records were reviewed for demographics, Injury Severity Score (ISS), chest tube interval (CTI), length of hospital stay (LOHS), interventions (including thoracoscopy and thoracotomy), and mortality.Results: There were no differences between both groups regarding age, ISS, interventions or mortality. However, patients receiving chest tubes in the 3rd through-5th ICS (High group) demonstrated significantly lower CTI and LOHS when controlling for age and ISS. (Multi-linear Regression, F-Value=3.14 and 9.44; p=0.027 and u003c0.0001, respectively)Conclusion: Low thoracotomy placement tubes are as safe as High placement with no difference in outcome in terms of morbidity and mortality. However, patients with low placement reported longer CTI and a longer LOHS.