Tube Thoracostomy: A Structured Review of Case Reports and a Standardized Format for Reporting Complications

Abstract

Introduction

Although seemingly straightforward, tube thoracostomy (TT) has been associated with complication rates as high as 30 %. A lack of a standardized nomenclature for reporting TT complications makes comparison and evaluation of reports impossible. We aim to develop a classification method in order to standardize the reporting of complications of TT and identify all reported complications of TT and time course in which they occurred to validate the reporting method.

Methods

A systematic search of MEDLINE, Scopus, EMBASE, and Cochrane Central Register of Controlled Trials and Database of Systematic Reviews from each databases inception through November 5, 2013 was conducted. Original articles written in the English language reporting TT complications were searched. This review adhered to preferred reporting items for systematic reviews and meta-analyses (PRISMA) standards. Duplicate reviewers abstracted case reports for inclusion. Cases were then sorted into one of the five complication categories by two reviewers, and in case of disagreements, settled by a third reviewer.

Results

Of 751 papers reporting TT complications, 124 case reports were included for analysis. From these reports, five main categories of TT complications were identified: insertional (n = 65); positional (n = 36); removal (n = 11); infective and immunologic (n = 7); and instructional, educational, or equipment related (n = 5). Placement of TT has occurred in nearly every soft tissue and vascular structure in the thoracic cavity and intra-abdominal organs.

Conclusion

Our classification method provides further clarity and systematic standardization for reporting TT complications.

Appendix: data sources and search strategies

Ovid

Database(s): Embase 1988 to 2013 Week 44, Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) 1946 to Present, EBM Reviews—Cochrane Central Register of Controlled Trials October 2013, EBM Reviews—Cochrane Database of Systematic Reviews 2005 to September 2013.

Search strategy

#	Searches	Results
1	exp Thoracostomy/ae [Adverse Effects]	259
2	exp thorax drainage/ae [Adverse Drug Reaction]	58
3	exp chest tube/ae [Adverse Drug Reaction]	301
4	exp Chest Tubes/ae [Adverse Effects]	301
5	exp Drainage/ae [Adverse Effects]	2914
6	(thoracostom* or thorocostom* or “thorax drain*” or “chest tube*” or “thorax tube*” or “chest drain*” or “thoraco stom*” or “intercostal drain*” or “thoracic drain*” or “thoracic tube*”).mp. [mp = ti, ab, sh, hw, tn, ot, dm, mf, dv, kw, nm, kf, ps, rs, ui, tx, ct]	20,473
7	5 and 6	222
8	complications.fs.	1,600,974
9	exp complication/	529,537
10	complication*.ti,ab.	1,303,099
11	exp Intraoperative Complications/or exp Postoperative Complications/	878,726
12	(kink* adj3 (tube* or tubing)).mp. [mp = ti, ab, sh, hw, tn, ot, dm, mf, dv, kw, nm, kf, ps, rs, ui, tx, ct]	285
13	(thoracostom* or thorocostom* or “thorax drain*” or “chest tube*” or “thorax tube*” or “chest drain*” or “thoraco stom*” or “intercostal drain*” or “thoracic drain*” or “thoracic tube*”).ti. and (8 or 9 or 10 or 11 or 12)	1100
14	((thoracostom* or thorocostom* or “thorax drain*” or “chest tube*” or “thorax tube*” or “chest drain*” or “thoraco stom*” or “intercostal drain*” or “thoracic drain*” or “thoracic tube*”) and (outcome* or risk or risks)).ti.	77
15	1 or 2 or 3 or 4 or 7 or 13 or 14	1571
16	exp controlled study/	4,271,968
17	exp evidence-based medicine/	686,470
18	evidence-based.mp.	236,814
19	(control$ adj2 (study or studies or trial or trials)).mp. [mp = ti, ab, sh, hw, tn, ot, dm, mf, dv, kw, nm, kf, ps, rs, ui, tx, ct]	5,385,792
20	meta analysis/	128,142
21	meta-analys$.mp.	208,153
22	exp “systematic review”/	65,764
23	(systematic* adj review$).mp.	160,836
24	exp Guideline/or exp Practice Guideline/	332,551
25	guideline$.ti.	107,550
26	exp case study/	1,702,380
27	follow up studies/	1,247,709
28	exp Cohort Studies/	1,623,501
29	exp longitudinal study/	1,036,416
30	exp retrospective study/	829,831
31	exp prospective study/	679,950
32	exp observational study/	45,997
33	exp comparative study/	2,511,563
34	exp clinical trial/	1,744,261
35	exp evaluation/	1,282,989
36	exp validation study/	43,257
37	exp experimental study/or exp field study/or in vivo study/or exp panel study/or exp pilot study/or exp prevention study/or exp quasi experimental study/or exp replication study/or exp theoretical study/or exp trend study/or clinical study/	1,789,177
38	((clinical or evaluation or validation or experimental or field or “in vivo” or panel or pilot or prevention or replication or theoretical or trend or population or concurrent or incidence or follow-up or observational or multivariate) adj (study or studies or survey or surveys or analysis or analyses or trial or trials)).mp.	5,319,847
39	(“case study” or “case series” or “clinical series” or “case studies”).mp. [mp = ti, ab, sh, hw, tn, ot, dm, mf, dv, kw, nm, kf, ps, rs, ui, tx, ct]	209,730
40	exp case study/	1,702,380
41	exp randomized controlled trial/	731,220
42	exp cross-sectional study/	290,467
43	crossover procedure/	38,797
44	exp cross-over studies/	98,605
45	multivariate analysis/	186,479
46	(randomized or randomised or comparative* or cohort* or longitudinal* or retrospectiv* or prospectiv* or “cross- sectional” or crossover or “cross-over” or “odds ratio” or “confidence interval” or study or analysis or analyses or review).mp. [mp = ti, ab, sh, hw, tn, ot, dm, mf, dv, kw, nm, kf, ps, rs, ui, tx, ct]	22,678,808
47	or/16-46	25,674,923
48	15 and 47	1217
49	from 15 keep 568-1527	960
50	limit 49 to (clinical trial or clinical trial, phase i or clinical trial, phase ii or clinical trial, phase iii or clinical trial, phase iv or comparative study or controlled clinical trial or guideline or meta analysis or multicenter study or practice guideline or randomized controlled trial) [Limit not valid in Embase,CDSR; records were retained]	172
51	48 or 50	1217
52	limit 51 to (book or book series or editorial or erratum or letter or note or addresses or autobiography or bibliography or biography or comment or dictionary or directory or interactive tutorial or interview or lectures or legal cases or legislation or news or newspaper article or overall or patient education handout or periodical index or portraits or published erratum or video–audio media or webcasts) [Limit not valid in Embase, Ovid MEDLINE(R),Ovid MEDLINE(R) In-Process, CCTR, CDSR; records were retained]	44
53	51 not 52	1173
54	from 15 keep 1528–1571	44
55	53 or 54	1173
56	55 not (exp animals/not humans/)	1154
57	limit 56 to english language [Limit not valid in CCTR, CDSR; records were retained]	1048
58	remove duplicates from 57	735

Scopus

• 1. TITLE (thoracostom* or “thorax drain*” or “chest tube*” or “thorax tube*” or “chest drain*” or “thoraco stom*” or “intercostal drain*” or “thoracic drain*” or “thoracic tube*” or thorocostom*).

• 2. TITLE-ABS-KEY(complication* or (kink* W/3 tube*) or (kink* W/3 tubing)).

• 3. TITLE(outcome* or risk or risks).

• 4. 1 and (2 or 3).

• 5. TITLE-ABS-KEY(comparative* OR cohort* OR longitudinal* OR retrospective* OR prospective* OR “cross-sectional” or crossover or “cross-over” or “odds ratio” or “confidence interval” or study or analysis or analyses or review or randomized or randomised or multivariate OR “population study” OR “population survey” OR “population analysis” OR “concurrent study” OR “concurrent survey” OR “concurrent analysis” or “incidence study” OR “incidence survey” OR “incidence analysis” OR “follow-up study” OR “follow-up survey” OR “follow-up analysis” or “panel study” OR “panel survey” OR “panel analysis” or “trend study” OR “trend survey” OR “trend analysis” or “observational study” OR “observational survey” OR “observational analysis” OR “case study” OR “case series” OR “clinical series” OR “case studies” or (evidence W/1 based) OR (meta W/1 analys*) OR (systematic* W/2 review*) OR guideline OR (control* W/2 stud*) OR (control* W/2 trial*) OR “clinical study” OR “clinical trial” or “evaluation study” OR “evaluation survey” OR “evaluation analysis” or “validation study” OR “validation survey” OR “validation analysis” or “experimental study” OR “experimental analysis” or “field study” OR “field survey” OR “field analysis” or “in vivo study” OR “in vivo analysis” or “pilot study” OR “pilot survey” OR “pilot analysis” or “prevention study” OR “prevention survey” OR “prevention analysis” or “replication study” OR “replication analysis” or “theoretical study” OR “theoretical analysis”).

• 6. 4 and 5.

• 7. LANGUAGE(english).

• 8. 6 and 7.

• 9. PMID(0*) OR PMID(1*) OR PMID(2*) OR PMID(3*) OR PMID(4*) OR PMID(5*) OR PMID(6*) OR PMID(7*) OR PMID(8*) OR PMID(9*).

• 10. 8 and not 9.

• 11. DOCTYPE(le) OR DOCTYPE(ed) OR DOCTYPE(bk) OR DOCTYPE(er)” OR DOCTYPE(no) OR DOCTYPE(sh).

• 12. 10 and not 11.