The risk factors and management of posttraumatic empyema in trauma patients.

BACKGROUND: Posttraumatic empyema increases patient morbidity, mortality and length of hospital stay, and the cost of treatment. The aim of this study was to identify the risk factors for posttraumatic empyema and to review our treatment outcomes in patients with this condition.

METHODS: A total of 2261 patients who were admitted with thoracic traumas and underwent tube thoracostomy between January 1989 and January 2006 were investigated retrospectively. Posttraumatic empyema developed in 71 patients. Logistic regression was used to assess the association between potential risk factors for posttraumatic empyema. All values were expressed as the mean+/-S.D.

RESULTS: Eight hundred and thirty-six (37%) of the patients had penetrating type trauma, while 1425 (63%) had blunt type trauma. The rate of posttraumatic empyema development was 3.1% for all patients. Pulmonary contusion was seen in 221 (9.8%) patients and fractures of more than two ribs were seen in 191 (8.4%) patients. Tube thoracostomy placement was performed in the emergency room in 1728 (76.4%) patients, in the hospital ward in 197 (8.7%), in the intensive care unit in 182 (8.0%), and in the operating room in 154 (6.8%). The duration of tube thoracostomy was 6.11+/-2.99 (1-21) days. Retained haemothorax was seen in 175 (7.7%) patients. The mean lengths of hospital and intensive care unit stay were 6.42+/-3.45 and 2.36+/-2.66 days, respectively. The analysis showed that duration of tube thoracostomy (OR, 2.49, p<0.001), length of intensive care unit stay (OR, 4.21, p<0.001), and presence of contusion (OR, 3.06, p<0.001), retained haemothorax (OR, 5.55, p<0.001), and exploratory laparotomy (OR, 2.46, p<0.001) were independent predictors of posttraumatic empyema. The relative risk of posttraumatic empyema was higher than 1 for each of the following risk factors: penetrating trauma (OR, 1.59, p=0.055), associated injuries (OR, 1.12, p=0.628) and fractures of more than two ribs (OR, 1.60, p=0.197).

CONCLUSION: Prolonged duration of tube thoracostomy and length of intensive care unit stay, and the presence of contusion, laparotomy and retained haemothorax are independent predictors of posttraumatic empyema. Use of prophylactic antibiotics may be recommended in patients with these risk factors.