Sisli Etfal Hastanesi tip bulteni · 2026
Pediatric Emergency Tube Thoracostomy: Complications and Independent Risk Factors in a Five-Year Cohort.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
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Sutasir Mehmet Necmeddin, Bas Ahmet, Zhanybekov Emir Zyanbekovich, Sarac Fatma
Аннотация
OBJECTIVES: Tube thoracostomy is a frequently performed emergency procedure in pediatric patients; however, complication patterns and risk stratification in emergency settings remain incompletely defined. This study aimed to evaluate 30-day complication rates and identify independent predictors of adverse outcomes in pediatric patients undergoing tube thoracostomy in emergency settings.
METHODS: This retrospective observational cohort study included 451 consecutive pediatric patients (0-18 years) who underwent tube thoracostomy between June 2020 and June 2025 at a tertiary referral center. Emergency settings included procedures performed in the Emergency Department (ED), Pediatric Intensive Care Unit (PICU), or urgent perioperative settings. The primary outcome was 30-day procedure-related complications. Variables with p<0.10 in univariate analysis were entered into a multivariate logistic regression model to determine independent predictors. Model calibration and discrimination were assessed using the Hosmer-Lemeshow test and the area under the receiver operating characteristic curve (AUC).
RESULTS: The overall 30-day complication rate was 21.3% (96/451). More than half of the procedures were performed in the ED (53.9%). Complication rates were highest in children younger than 6 years (38.2%, p=0.001) and in those with traumatic presentations (36.0% vs. 19.5%, p=0.04). General anesthesia was associated with higher complication rates compared with local anesthesia with or without sedation (34.5% vs. 13.4%, p<0.001). Multivariate analysis identified age <6 years (adjusted OR: 2.42, 95% CI: 1.38-4.24), traumatic etiology (adjusted OR: 1.86, 95% CI: 1.02-3.39), and general anesthesia (adjusted OR: 2.18, 95% CI: 1.34-3.54) as independent predictors. Procedure location was not independently associated with complications. Model discrimination was acceptable (AUC: 0.71).
CONCLUSION: In pediatric emergency tube thoracostomy, younger age, traumatic presentation, and the use of general anesthesia are independently associated with 30-day complications. Comparable complication rates across the ED and other emergency settings support the safety of emergency department-based tube thoracostomy when performed by trained providers. These findings may guide risk stratification and clinical decision-making in pediatric emergency medicine.
METHODS: This retrospective observational cohort study included 451 consecutive pediatric patients (0-18 years) who underwent tube thoracostomy between June 2020 and June 2025 at a tertiary referral center. Emergency settings included procedures performed in the Emergency Department (ED), Pediatric Intensive Care Unit (PICU), or urgent perioperative settings. The primary outcome was 30-day procedure-related complications. Variables with p<0.10 in univariate analysis were entered into a multivariate logistic regression model to determine independent predictors. Model calibration and discrimination were assessed using the Hosmer-Lemeshow test and the area under the receiver operating characteristic curve (AUC).
RESULTS: The overall 30-day complication rate was 21.3% (96/451). More than half of the procedures were performed in the ED (53.9%). Complication rates were highest in children younger than 6 years (38.2%, p=0.001) and in those with traumatic presentations (36.0% vs. 19.5%, p=0.04). General anesthesia was associated with higher complication rates compared with local anesthesia with or without sedation (34.5% vs. 13.4%, p<0.001). Multivariate analysis identified age <6 years (adjusted OR: 2.42, 95% CI: 1.38-4.24), traumatic etiology (adjusted OR: 1.86, 95% CI: 1.02-3.39), and general anesthesia (adjusted OR: 2.18, 95% CI: 1.34-3.54) as independent predictors. Procedure location was not independently associated with complications. Model discrimination was acceptable (AUC: 0.71).
CONCLUSION: In pediatric emergency tube thoracostomy, younger age, traumatic presentation, and the use of general anesthesia are independently associated with 30-day complications. Comparable complication rates across the ED and other emergency settings support the safety of emergency department-based tube thoracostomy when performed by trained providers. These findings may guide risk stratification and clinical decision-making in pediatric emergency medicine.