| Background:Traumatic hemothorax is one of the common injuries after thoracic trauma,and if not treated promptly,it can lead to serious complications.There are a few studies to analyze risk factors and prognosis of conservative treatment failure in patients with traumatic hemothorax after blunt thoracic trauma.This article conducted a retrospective analysis of patients with traumatic hemothorax after the blunt thoracic trauma to determine the risk factors of conservative treatment failure in patients with traumatic hemothorax,and to evaluate the impact of different treatment options on the outcome of patients with traumatic hemothorax,to provide a reference for selective invasive treatment and prognosis assessment of patients with traumatic hemothorax.Methods:A retrospective analysis was performed on the clinical records of hospitalized patients who were diagnosed with traumatic hemothorax after blunt thoracic trauma from January 1,2020,to June 1,2021,in the Trauma Center of the First Affiliated Hospital of Soochow University who met the inclusion and exclusion criteria,and divided into the successful group with 98 cases and the failed group with 56 cases according to whether the conservative treatment of traumatic hemothorax patients who adopted conservative treatment after the initial evaluation of admission was successful.The possible factors affecting the effect of conservative treatment were analyzed,and the T-test was used for univariate analysis measurement data,the chi-square test was used for counting data,and the statistically significant influencing factors in univariate analysis were analyzed by multivariate binary logistic regression model to determine the independent risk factors for the conservative treatment failure of patients with traumatic hemothorax.And it was divided into the conservative treatment group with 154 cases and 123 cases in the invasive treatment group according to whether the patients with traumatic hemothorax took conservative treatment options after the initial assessment of admission.And divided into the early invasive treatment group and the late invasive treatment group(conservative treatment failure)according to the timing of performing invathe sive treatment.Length of hospital stay,ICU admission,mortality,empyema incidence,discharge outcome and other outcome events were analyzed.Results:Finally,a total of 154 patients with traumatic hemothorax who were initially conservatively treated were included in the study,and univariate analysis showed that there were significant differences in the history of diabetes,combined pneumothorax,hematoma thickness≥ 1.5cm in CT,ventilator use,and serum albumin level(Albumin,Alb)between the successful group and the failed group(P<0.05).The results of multivariate binary logistic regression analysis showed that the history of diabetes(P=0.002,OR=4.467,95%CI 1.719-11.610),combined pneumothorax(P<0.001,OR=7.653,95%CI 2.887-20.283),hematoma thickness≥1.5cm in CT(P=0.045,OR=2.703,95%CI 1.020-7.162),serum albumin≤30.5g/L(P<0.001,OR=6.251,95%CI 2.367-16.505),ventilator use(P=0.002,OR=4.829,95%CI 1.792-13.015)were independent risk factors for conservative failure(P<0.05).Analysis of the prognosis of patients with the initial conservative treatment and the initial invasive treatment showed that patients in the invasive treatment group had a longer length of hospital stay(23days vs 17days,P<0.001),higher ICU admission(29.3%vs.14.3%,P=0.002).And the proportion of patients in the invasive treatment group who continued rehabilitation after discharge was significantly higher than that in the conservative treatment group(36.6%VS 21.4%,P=0.005).The prognosis of patients between the early invasive treatment group and the late invasive treatment group were analyzed,and the results showed that the length of hospital stay was longer in the early invasive treatment group(23days VS 15days,P<0.001).But the proportion of continued rehabilitation after discharge(36.6%VS 53.6%,P=0.033)in the late invasive treatment group was much less.There was no statistically significant difference in mortality between the groups(P>0.05).Conclusion:1.Some patients with traumatic hemothorax can be safely and conservatively managed.2.There are many influencing factors affecting the conservative treatment failure in patients with traumatic hemothorax,among which:the history of diabetes,combined pneumothorax,hemothorax thickness of>1.5 cm in CT,serum albumin≤30.5g/L,and ventilator use are independent risk factors for conservative treatment failure in patients with traumatic hemothorax.3.Avoidance of unnecessary invasive treatments may improve patient outcomes,whereas remedial invasive treatment after conservative treatment failure hardly increases the risk of adverse outcome events.This study has the potential to help clinicians better understand the possible risks of initial conservative treatment and the influencing factors of conservative treatment failure in patients with traumatic hemothorax to improve clinical decision-making. |
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