Readmission for pleural space complications after chest wall injury: Who is at risk?

BACKGROUND: Little is known about patient characteristics predicting post-discharge pleural space complications (PDPSC) after thoracic trauma. We sought to analyze the patient population who required unplanned hospital readmission for PDPSC.

METHODS: Retrospective review of adult patients admitted to a level I Trauma Center with a chest AIS score ≥ 2 between January 2015 and August 2020. Those readmitted within 30 days of index hospitalization discharge for PDPSC were compared to those not readmitted. Demographics, injury characteristics, surgical procedures, imaging and readmission data were retrieved.

RESULTS: Out of 17,192 trauma evaluations, 3,412 (19.8%) suffered a chest AIS ≥2 injury and 155 experienced an unplanned 30-day hospital readmission. Of those, 49(1.4%) were readmitted for the management of PDPSC (Readmit PDPSC) and were compared to patients who were not readmitted (No Readmit, n = 3,257). The Readmit PDPSC group was significantly older age, heavier, comprised of fewer males, and suffered a higher mean chest AIS score. The Readmit PDPSC group had a significantly higher incidence of rib fractures, flail chest, pneumothorax, hemothorax, scapula fractures, and a higher rate of tube thoracostomy placement during index admission. The discharge chest X-ray in the Readmit PDPSC group demonstrated a pleural space abnormality in 36(73%) of patients. Mean time to readmission was 10.2(7.2) days, and hospital LOS on readmission was 5.8(3.7) days. Pleural effusion was the most common readmission diagnosis (44[90%]), and 42(86%) required tube thoracostomy.

CONCLUSIONS: We describe the subset of chest wall injury patients who require hospital readmission for PDPSC. Characteristics from index hospitalization associated with PDPSC include older age, female gender, heavier weight, presence of rib fractures, pleural space abnormality, scapular fracture, and chest tube placement. Further studies are needed to characterize this at-risk chest wall injury population, and to determine what interventions can facilitate outpatient management of DPSC and mitigate readmission risk.Level IV, prognostic and epidemiologic.