Traumatic Intercostal Chest Drain (ICD) Insertions and their Complications in a Rural New Zealand (NZ) Hospital
Authors List
Emma Imbert, MBBS, Paul Manuel, MD, FRCSC, and Meghann Anderson, MBBS
Introduction
Intercostal chest drain (ICD) insertion is a common procedure performed for trauma patients. Studies have suggested that less experienced staff and placement of large bore ICDs are associated with higher rates of complications. Our audit addresses how overall experience is associated with complication rates in the setting of a rural New Zealand (NZ) hospital.
Methods
Retrospective study of complications from ICD insertion in a rural NZ hospital over a 5y period (January 2018 - December 2022). Complications were graded I-V as per a modified surgical complications scale.
Results
94 ICDs were inserted in 76 patients. 72% of patients were male, with a median age of 52.5y (range 11-95y). 33% of patients sustained multiple injuries from a road traffic collision, 35% sustained other high impact mechanisms of injury, 5% had penetrating injuries, and 7% were iatrogenic. 62% of drains were inserted by junior staff and 14% by senior medical officers. Surgical department personnel inserted 41% of ICDs and emergency department (ED) staff inserted 38%.
52 complications were noted: 15 grade 0 (no change in management); 8 grade I; 5 grade II (requiring antibiotics); 12 grade IIIa (requiring further chest drains to be inserted) and a single patient needed operative management (grade IIIb); 7 deaths (grade V) were noted but not as a direct result of ICD insertion. 7 complications were “technical”, most of which were disconnections of the tubing/dressing.
Junior and senior staff had very similar grade III rates (15% and 14% respectively). ED and surgery also had similar grade III rates (15% and 17% respectively). There were twice as many grade III complications with the insertion of small bore ICDs.
Conclusions
Our study did not support that more junior staff or any specific speciality had more complications per ICD inserted.
Emma Imbert, MBBS, Paul Manuel, MD, FRCSC, and Meghann Anderson, MBBS
Introduction
Intercostal chest drain (ICD) insertion is a common procedure performed for trauma patients. Studies have suggested that less experienced staff and placement of large bore ICDs are associated with higher rates of complications. Our audit addresses how overall experience is associated with complication rates in the setting of a rural New Zealand (NZ) hospital.
Methods
Retrospective study of complications from ICD insertion in a rural NZ hospital over a 5y period (January 2018 - December 2022). Complications were graded I-V as per a modified surgical complications scale.
Results
94 ICDs were inserted in 76 patients. 72% of patients were male, with a median age of 52.5y (range 11-95y). 33% of patients sustained multiple injuries from a road traffic collision, 35% sustained other high impact mechanisms of injury, 5% had penetrating injuries, and 7% were iatrogenic. 62% of drains were inserted by junior staff and 14% by senior medical officers. Surgical department personnel inserted 41% of ICDs and emergency department (ED) staff inserted 38%.
52 complications were noted: 15 grade 0 (no change in management); 8 grade I; 5 grade II (requiring antibiotics); 12 grade IIIa (requiring further chest drains to be inserted) and a single patient needed operative management (grade IIIb); 7 deaths (grade V) were noted but not as a direct result of ICD insertion. 7 complications were “technical”, most of which were disconnections of the tubing/dressing.
Junior and senior staff had very similar grade III rates (15% and 14% respectively). ED and surgery also had similar grade III rates (15% and 17% respectively). There were twice as many grade III complications with the insertion of small bore ICDs.
Conclusions
Our study did not support that more junior staff or any specific speciality had more complications per ICD inserted.
