VATS versus intrapleural streptokinase: A prospective, randomized, controlled clinical trial for optimum treatment of post-traumatic Residual Hemothorax.

Abstract

BACKGROUND:

Post-traumatic residual haemothorax (RH) is common and carries significant morbidity. However, its optimal treatment is not clear.

AIM:

The aim of this study was to find the extent of this problem and the choice of treatment between VATS and intra-pleural streptokinase instillation (IPSI).

MATERIAL AND METHODS:

This RCT, conducted over 18 months period, included all patients of chest trauma between 18 and 70 years of age, admitted with haemothorax or haemopneumothorax requiring inter-costal drain (ICD) insertion. 154 events of haemothorax/haemopneumothorax requiring ICD insertion were enrolled. RH was seen in 48 (31%) patients: 13 patients were excluded from RCT after refusal for treatment. Seventeen (49%) patients of remaining 35 RH cases were randomized to IPSI group and 18 (51%) patients were randomized to VATS group. The outcome parameters were resolution of RH and treatment related complications.

RESULTS:

RH resolved equally well in VATS and IPSI group [13 patients (72%) versus 12 patients (71%), respectively; continuity-adjusted p=1]. Morbidity wise no difference (p-value 0.529) was seen in the two groups.

CONCLUSION:

Post-traumatic RH is seen in 1/3rd patients and is equally well treated by VATS and IPSI.

• Authors: S Kumar, V Rathi, A Rattan, S Chaudhary, N Agarwal
• Journal: Injury (Injury) Vol. 46 Issue 9 Pg. 1749-52 (Sep 2015) ISSN: 1879-0267 [Electronic] Netherlands
• PMID: 25813733 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)
• Copyright: Copyright © 2015 Elsevier Ltd. All rights reserved.

Chemical References

• Fibrinolytic Agents
• Streptokinase

Topics

• Adult
• Chest Tubes
• Drainage
• Female
• Fibrinolytic Agents (administration & dosage)
• Hemothorax (drug therapy, etiology, mortality, surgery, therapy)
• Humans
• India (epidemiology)
• Length of Stay
• Male
• Prospective Studies
• Streptokinase (administration & dosage)
• Thoracic Injuries (complications, mortality, therapy)
• Thoracic Surgery, Video-Assisted
• Thrombolytic Therapy
• Wounds, Nonpenetrating (complications, mortality, therapy)