Complications of Tube Thoracostomy Placement in the Emergency Department

Kinjal N. Sethuraman, MD, MPH; David Duong, MD; Supriya Mehta, PHD; Tara Director, MD; Darcey Crawford, MD; Jill St. George, BS; Niels K. Rathlev, MD


J Emerg Med. 2011;40(1) 

In This Article

Abstract and Introduction


Background: Emergency medicine residents frequently perform invasive procedures, including tube thoracostomy (TT), that inherently place patients at risk for complications. Objectives: The purpose of the study was to assess the prevalence and types of complications from TT in an academic emergency department (ED).
Methods: A combined prospective and retrospective, observational study of all patients who had TT between December 2002 and January 2006 was performed. Exclusion criteria included age < 15 years and tube placement at an outside facility. Complications detected in the ED were defined as immediate, whereas those discovered later were defined as delayed. Complications requiring corrective surgical intervention, administration of blood products, or intravenous antibiotics were defined as major. Bivariate and multivariate analyses were used to identify operator and patient factors associated with complications.
Results: TTs were placed in 242 patients, and 90 (37%; 95% confidence interval [CI] 31.1–43.3%) experienced a complication. Major complications included one intercostal artery laceration, one retroperitoneal placement, and empyema in 2 patients. In multivariate analysis, blunt injury excluding motor vehicle accidents (odds ratio [OR] 2.57; 95% CI 1.27–5.21) and spontaneous pneumothorax (OR 3.84; 95% CI 1.80–8.18) were associated with all complications. TT size < 36 French and blunt injury excluding motor vehicle accidents were associated with immediate complications and spontaneous pneumothorax was associated with delayed complications.
Conclusions: The vast majority of complications from TT in the ED were minor. The prevalence of complications was consistent with previous reports of TTs placed by non-emergency-medicine-trained physicians outside the ED. The findings can be used to identify avoidable complications and improve residency training.


Tube thoracostomy (TT) is an example of an invasive procedure that inherently places patients at risk for complications. Potential complications include misplacement of the tube, unresolved pneumothorax, empyema, laceration of thoracic vessels, and injury to the lung and heart. Although previous studies describe complications from TT in various hospital settings performed by physicians from a variety of specialties, occurrences in an academic emergency department (ED) with an emergency medicine residency have not been described extensively.[1–4] The purpose of this investigation was to evaluate the prevalence and types of complications resulting from TT insertion in a setting where the procedure is primarily performed by emergency medicine residents and to identify specific patient and procedural characteristics that may predict the potential for complications. Predictors of complications were identified by multivariate logistic regression analysis. This information may be used to reduce the risk of adverse outcomes to patients from TT by identifying the prevalence and types of complications and by guiding further procedural training.


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