{
  "abstract": "Aims and Objectives Debate exists over using large-bore (>24Fr) surgical drains versus small-bore (<14Fr) Seldinger drains in traumatic pneumothorax. Traditionally, large-bore drains have been used in trauma practice, but evidence from small studies suggests small-bore drains have benefits such as reduced complications, reduced drain duration and improved patient comfort. This analysis explores the major complication rates between small-bore Seldinger and large-bore chest drains in traumatic pneumothorax.Method and Design This was a post-hoc unplanned secondary analysis of the COMITED trial cohort of adult patients who presented to UK Emergency Departments with traumatic pneumothorax. In COMITED patients were randomised to receive either a chest drain or conservative management. Importantly, the choice of chest drain was not controlled and was left to clinician choice. The primary outcome for this analysis was major chest-drain related complication at 30days, defined as ≥ one of: major drain-related complication, requiring subsequent pleural intervention (excluding the first drain) or chest-injury related mortality.Abstract 4230 Table 1Primary outcome of major chest drain related complications at 30 days post-randomisation Primary Outcome Total N= 143 Large-bore drain N=101 Small bore Seldinger drain N= 42 Risk Ratio , 95% CI Any Major chest drain related complication* (>1) (n,%) 31 (21.7%) 16 (15.8%) 15 (35.7%) 2.25 (1.23-4.13) Mortality § (n,%) 4 (2.8%) 1 (1%) 3 (7.14) Subsequent pleural intervention: Subsequent pleural intervention total (n,%) 17 (11.9%) 10 (9.9%) 7 (16.7%) Emergency subsequent pleural intervention (n,%) 9 (6.3%) 5(5.0%) 4(9.5%) Non-emergency subsequent pleural intervention (n,%) 8(5.6%) 5(5.0%) 3(7.1%) Chest-drain complication category: Insertional complications (n,%) 3 (2.1%) 1 (1%) 2 (4.8%) Positional complications (n,%) 2 (1.4%) 2 (2.0%) 0 (0%) Removal complications (n,%) 1 (0.7%) 0 (0%) 1 (2.4%) Infective complications (n,%) 3 (2.1%) 2 (2.0%) 1 (2.4%) Failure (n,%) 7 (4.9%) 3 (3.0%) 4 (9.5%) Instructional/ /equipment related complications (n,%) 0 (0%) 0 (0%) 0 (0%) *Major chest drain-related complications were a binary outcome (>1 event per participant) of mortality, subsequent pleural intervention or chest-drain complication. § Chest-injury and/or pneumothorax related mortality.Results and Conclusion Of 400 participants, 143 received a chest drain before 30 days. 101 (70.6%) received large-bore (>24Fr) surgical drains and 42 (29.4%) received small-bore (<14Fr) Seldinger drains ( table 1). Patients who received large-bore drains were younger (mean age 53.8 vs 60.5 years) and more likely to be male (78.2% vs 69%). Patients who received large-bore drains also had higher injury severity scores (mean 19.3 (SD+ 14) vs 10.1(SD+5.6)) and had higher rates of mechanical ventilation (15.8%vs2.4%) Small-bore drains were associated with higher major complication rates at 30 days, Relative Risk 2.25 (35.7%vs15.8%,95%CI; 1.23-4.13). Within the limitations of this post-hoc secondary analysis we found around 30% of traumatic pneumothoraces were drained using small-bore Seldinger drains. When used in this cohort, major complication rates appear higher which is contrary to existing evidence. The COMITED-2 trial will overcome the limitations of evaluating post-randomisation interventions to definitively answer whether small-bore Seldinger chest drains are superior in trauma.",
  "authors": [
    {
      "affiliations": [
        "University Hospitals Bristol and Weston NHS Foundation Trust"
      ],
      "name": "Olivia Mackay"
    },
    {
      "affiliations": [
        "University Hospital Bristol and Weston"
      ],
      "name": "Frances Steele"
    },
    {
      "affiliations": [
        "North Bristol NHS Trust"
      ],
      "name": "Edward Carlton"
    },
    {
      "affiliations": [
        "University of Bristol"
      ],
      "name": "On behalf of the COMITED Investigators"
    }
  ],
  "title": "4230 Major complications of small-bore seldinger chest drains vs large-bore chest drains in traumatic pneumothorax: a secondary exploratory analysis of the CoMiTED trial",
  "uid": "55d5a382-9c2e-5e6c-a95a-b8972fe7bdf5"
}