STANDARDIZED CHEST TUBE MANAGEMENT PROTOCOL FOR TRAUMA PATIENTS SIGNIFICANTLY REDUCES COMPLICATIONS IN PAKISTAN
Main Article Content
Keywords
trauma, chest injuries, chest tube management, standardized protocol, complications, Pakistan.
Abstract
Introduction: Trauma is the primary cause of morbidity and death around the world, and chest injuries account for a large portion of these cases. In Pakistan, the high prevalence of trauma-related chest injuries necessitates effective management to reduce complications such as infections, tube dislodgement, and pneumothorax. The lack of standardized chest tube management protocols has contributed to inconsistent patient outcomes.
Objective: This study aimed to evaluate the impact of a standardized protocol for chest tube management on complication rates in trauma patients across major hospitals in Pakistan.
Methodology: A prospective cohort study was conducted involving 60 trauma patients requiring chest tube insertion, divided equally into pre-protocol and post-protocol groups. The standardized protocol included guidelines on chest tube insertion, maintenance, monitoring, and removal. Data on patient demographics, trauma characteristics, and complications were collected over 12 months. Using chi-square tests for categorical data and t-tests for continuous variables, statistical analysis was carried out using SPSS.
Results: The pre-protocol group's mean age was 35.2 ± 10.5 years, while the post-protocol group's mean age was 34.8 ± 9.8 years (p = 0.88). From 25% in the pre-protocol group to 10% in the post-protocol group, the overall complication rate dropped dramatically (p < 0.01). Tube dislodgement decreased from 10% to 3% (p < 0.05), and infection rates fell from 15% to 5% (p < 0.05). The average duration of hospitalization decreased to 8.6 ± 2.5 days from 12.4 ± 3.2 days (p < 0.01).
Conclusion: Implementing a standardized chest tube management protocol significantly reduced complications, shortened hospital stays, and improved patient outcomes. Further research with larger samples and extended follow-up is recommended to validate these findings.
References
2. Hajjar WM, Al-Nassar SA, Almutair OS, Alfahadi AH, Aldosari NH, Meo SA. Chest Trauma Experience: Incidence, associated factors, and outcomes among patients in Saudi Arabia. Pakistan Journal of Medical Sciences. 2021 Mar;37(2):373.
3. Dogrul BN, Kiliccalan I, Asci ES, Peker SC. Blunt trauma related chest wall and pulmonary injuries: An overview. Chinese journal of traumatology. 2020 Jun 1;23(03):125-38.
4. Ball CG, Lord J, Laupland KB, Gmora S, Mulloy RH, Ng AK, Schieman C, Kirkpatrick AW. Chest tube complications: how well are we training our residents?. Canadian Journal of Surgery. 2007 Dec;50(6):450.
5. Hyder AA, Razzak JA. The challenges of injuries and trauma in Pakistan: an opportunity for concerted action. Public health. 2013 Aug 1;127(8):699-703.
6. Naz L, Ghimire U, Zainab A. Behavioral factors associated with utilization of healthcare services among elderly in Pakistan: evidence from a nationally representative survey. BMC geriatrics. 2021 Dec;21:1-1.
7. Dimmer A, Baird R, Puligandla P. Role of practice standardization in outcome optimization for CDH. World Journal of Pediatric Surgery. 2024;7(2).
8. Turaga AH. Enhanced Recovery After Surgery (ERAS) protocols for improving outcomes for patients undergoing major colorectal surgery. Cureus. 2023 Jul 12;15(7).
9. Dai CA, Fang CJ, Schwartz D, Enderson J, McMann A, Hyde R, Smith N, Serfin J. Standardized Protocol for Chest Tube Management for Trauma Patients Significantly Decreases Complications. Surgery Research and Practice. 2023 Sep 21;2023.
10. Kobayashi I, Sledjeski EM, Delahanty DL. Gender and age interact to predict the development of posttraumatic stress disorder symptoms following a motor vehicle accident. Psychological Trauma: Theory, Research, Practice, and Policy. 2019 Mar;11(3):328.
11. Bolandparvaz S, Yadollahi M, Abbasi HR, Anvar M. Injury patterns among various age and gender groups of trauma patients in southern Iran: A cross-sectional study. Medicine. 2017 Oct 1;96(41):e7812.
12. Walia BS, Dugg P, Sharma S. Clinical Features, Management, and Outcomes of Chest Trauma at a Tertiary-Care Centre in India: A Retrospective Observational Study. The Scientific World Journal. 2021 Nov 16;2021:1-4.
13. Lustenberger T, Meier SL, Verboket RD, Störmann P, Janko M, Frank J, Marzi I. The implementation of a complication avoidance care bundle significantly reduces adverse surgical outcomes in orthopedic trauma patients. Journal of clinical medicine. 2020 Dec 11;9(12):4006.
14. Desai VR, Raskin JS, Mohan A, Montojo J, Briceño V, Curry DJ, Lam S. A standardized protocol to reduce pediatric baclofen pump infections: a quality improvement initiative. Journal of Neurosurgery: Pediatrics. 2018 Apr 1;21(4):395-400.
15. Rosenberger LH, Guidry CA, Davis JP, Hranjec T, Johnston VK, Wages NA, Watson CM, Sawyer RG. Reducing accidental dislodgement of the percutaneous endoscopic gastrostomy: A prospective trial of the “safetybreak” device. Surgical innovation. 2016 Feb;23(1):62-9.
16. Lee HW, Park Y, Jang EJ, Lee YJ. Intensive care unit length of stay is reduced by protocolized family support intervention: a systematic review and meta-analysis. Intensive care medicine. 2019 Aug 1;45:1072-81.
17. El-Faramawy A, Jabbour G, Afifi I, Abdelrahman H, Qabbani AS, Al Nobani M, Mekkodathil AA, Al-Thani H, El-Menyar A. Complications following chest tube insertion pre-and post-implementation of guidelines in patients with chest trauma: A retrospective, observational study. International Journal of Critical Illness and Injury Science. 2020 Oct 1;10(4):189-94.