Skip to main content
Log in

Predictors of retained hemothorax after trauma and impact on patient outcomes

  • Original Article
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript



Hemo/pneumothoraces are a common result of thoracic injury. Some of these injuries will be complicated by retained hemothorax (RH), which has previously been shown to be associated with longer hospitalizations. It has been proposed that early versus delayed intervention with video-assisted thoracoscopic surgery can reduce the duration of mechanical ventilation, hospital and ICU LOS, and costs in patients with RH. However, little is known regarding the effect of RH on these outcomes relative to patients with uncomplicated hemo/pneumothoraces. The aim of our study was to characterize factors present on admission that may be associated with RH and assess the impact of RH on outcomes.


A retrospective chart review was conducted and included all patients who underwent tube thoracostomy (TT) for traumatic hemo/pneumothorax admitted to a single urban adult and pediatric level I trauma center from January 2008 to September 2013.


The study cohort included 398 patients, 17.6 % developed RH. RH was associated with significantly longer total duration of TT drainage (p < 0.001), hospital LOS (p < 0.001), and total hospital charges (p < 0.001). These associations remained significant in a subgroup analysis excluding patients with traumatic brain injury. Patients with bilateral injuries (OR 4.25, p < 0.001) and patients intubated on the day of admission (OR 2.30, p = 0.002) were significantly more likely to develop RH. There was also a small, but highly significant, association between increasing ISS and the development of RH (OR 1.07, p < 0.001).


Our study suggests patients requiring ventilator support on admission and those with bilateral injuries are at increased risk of developing RH. Early identification of patients at risk for RH may allow for earlier intervention and potential benefits to the patient.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others


  1. Nance ML, editor. National trauma data bank annual report. American College of Surgeons; 2014.

  2. Karmy-Jones R, Holevar M, Sullivan RJ, Fleisig A, Jurkovich GJ. Residual hemothorax after chest tube placement correlates with increased risk of empyema following traumatic injury. Can Respir J. 2008;15:255–8.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Aguilar MM, Battistella FD, Owings JT, Su T. Posttraumatic empyema. Risk factor analysis. Arch Surg 1997;132:647–50; discussion 650–1. doi:10.1001/archsurg.1997.01430300089018.

  4. Eren S, Esme H, Sehitogullari A, Durkan A. The risk factors and management of posttraumatic empyema in trauma patients. Injury. 2008;39:44–9. doi:10.1016/j.injury.2007.06.001.

    Article  PubMed  Google Scholar 

  5. DuBose J, Inaba K, Okoye O, Demetriades D, Scalea T, O’Connor J, et al. Development of posttraumatic empyema in patients with retained hemothorax: results of a prospective, observational AAST study. J Trauma Acute Care Surg. 2012;73:752–7. doi:10.1097/TA.0b013e31825c1616.

    Article  PubMed  Google Scholar 

  6. MacLeod JB, Ustin JS, Kim JT, Lewis F, Rozycki GS, Feliciano DV. The epidemiology of traumatic hemothorax in a level I trauma center: case for early video-assisted thoracoscopic surgery. Eur J Trauma Emerg Surg. 2010;36:240–6. doi:10.1007/s00068-009-9119-8.

    Article  PubMed  Google Scholar 

  7. Morales Uribe CH, Villegas Lanau MI, Petro Sánchez RD. Best timing for thoracoscopic evacuation of retained post-traumatic hemothorax. Surg Endosc Other Interv Tech 2008;22:91–5. doi:10.1007/s00464-007-9378-6.

  8. Smith JW, Franklin GA, Harbrecht BG, Richardson JD. Early VATS for blunt chest trauma: a management technique underutilized by acute care surgeons. J Trauma. 2011;71:102–7. doi:10.1097/TA.0b013e3182223080.

    Article  PubMed  Google Scholar 

  9. Lin H-L, Huang W-Y, Yang C, Chou S-M, Chiang H-I, Kuo L-C, et al. How early should VATS be performed for retained haemothorax in blunt chest trauma? Injury. 2014;45:1359–64. doi:10.1016/j.injury.2014.05.036.

    Article  PubMed  Google Scholar 

  10. Mowery NT, Gunter OL, Collier BR, Diaz JJ, Haut E, Hildreth A, et al. Practice management guidelines for management of hemothorax and occult pneumothorax. J Trauma. 2011;70:510–8. doi:10.1097/TA.0b013e31820b5c31.

    Article  PubMed  Google Scholar 

  11. DuBose J, Inaba K, Demetriades D, Scalea TM, O’Connor J, Menaker J, et al. Management of post-traumatic retained hemothorax: a prospective, observational, multicenter AAST study. J Trauma Acute Care Surg 2012;72:11–22. doi:10.1097/TA.0b013e318242e368.

  12. Trupka a, Waydhas C, Hallfeldt KK, Nast-Kolb D, Pfeifer KJ, Schweiberer L. Value of thoracic computed tomography in the first assessment of severely injured patients with blunt chest trauma: results of a prospective study. J Trauma 1997;43:405–11; discussion 411–2.

  13. Velmahos GC, Demetriades D, Chan L, Tatevossian R, Cornwell EE, Yassa N, et al. Predicting the need for thoracoscopic evacuation of residual traumatic hemothorax: chest radiograph is insufficient. J Trauma. 1999;46:65–70. doi:10.1097/00128594-199910000-00018.

    Article  CAS  PubMed  Google Scholar 

  14. Menger R, Telford G, Kim P, Bergey MR, Foreman J, Sarani B, et al. Complications following thoracic trauma managed with tube thoracostomy. Injury. 2012;43:46–50. doi:10.1016/j.injury.2011.06.420.

    Article  PubMed  Google Scholar 

  15. Heniford BT, Carrillo EH, Spain DA, Sosa JL, Fulton RL, Richardson JD. The role of thoracoscopy in the management of retained thoracic collections after trauma. Ann Thorac Surg. 1997;63:940–3. doi:10.1016/S0003-4975(97)00173-2.

    Article  CAS  PubMed  Google Scholar 

  16. Meyer DM, Jessen ME, Wait MA, Estrera AS. Early evacuation of traumatic retained hemothoraces using thoracoscopy: a prospective, randomized trial. Ann Thorac Surg. 1997;64:1396–401. doi:10.1016/S0003-4975(97)00899-0.

    Article  CAS  PubMed  Google Scholar 

  17. Vassiliu P. Timing, safety, and efficacy of thoracoscopic evacuation of undrained post-traumatic hemothorax. Am Surg. 2001;67:1165–9.

    CAS  PubMed  Google Scholar 

  18. Morrison CA, Lee TC, Wall MJ, Carrick MM. Use of a trauma service clinical pathway to improve patient outcomes for retained traumatic hemothorax. World J Surg. 2009;33:1851–6. doi:10.1007/s00268-009-0141-0.

    Article  PubMed  Google Scholar 

  19. Ahmed N, Chung R. Role of early thoracoscopy for management of penetrating wounds of the chest. Am Surg. 2010;76:1236–9.

    PubMed  Google Scholar 

  20. Varin DSE, Ringburg AN, van Lieshout EMM, Patka P, Schipper IB. Accuracy of conventional imaging of penetrating torso injuries in the trauma resuscitation room. Eur J Emerg Med. 2009;16:305–11. doi:10.1097/MEJ.0b013e32832c3ab9.

    Article  PubMed  Google Scholar 

Download references


The authors would like to thank Jessica Malone for her help in the data gathering. We would also like to thank Greg Kassmir and Bridget Morrison for their help in identifying patients in the trauma database. The general surgery resident education fund sponsored resident travel to present preliminary results from this study at a conference. Funding sponsors had no involvement in study design; collection, analysis, and interpretation of data; the writing of the manuscript; or the decision to submit the manuscript for publication.

Author information

Authors and Affiliations


Corresponding author

Correspondence to R. M. Nygaard.

Ethics declarations

Conflict of interest

Mark F. Scott, Reza A. Khodaverdian, Jessica L. Shaheen, Arthur L. Ney, and Rachel M. Nygaard declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Scott, M.F., Khodaverdian, R.A., Shaheen, J.L. et al. Predictors of retained hemothorax after trauma and impact on patient outcomes. Eur J Trauma Emerg Surg 43, 179–184 (2017).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: