An observational approach to haemothoraces- A single centre review

<bold>Introduction:</bold> Traumatic haemothoraces are historically managed by the insertion of a thoracostomy tube (TT), the rationale for which is a predisposition to pleural infection caused by blood in the pleural space. There is limited data on conservative management of traumatic haemothoraces, with no randomised controlled trials (RCTs) comparing observation to TT. There are, however, guidelines that propose a role for observation in small-to-moderate haemothoraces. The management of traumatic haemothoraces has been run by respiratory physicians at our unit where a conservative approach in selected cases has been adopted. Method This is a retrospective observational review of all cases of traumatic haemothoraces admitted to a single centre in the UK, between January 2022 and September 2023. Patient hospital stays and outcomes were analysed descriptively with the outcome of interest being development of pleural infection. <bold>Results:</bold> 43 patients were admitted with a traumatic haemothorax within the analysis period. 39 patients (90.7%) were managed conservatively. Four (9.3%) patients received TT for large haemothoraces or haemopneumothoraces. In the conservative group, all had small-to-moderate haemothoraces on CT chest. There were no cases of pleural infection during admission in either group, with an average length of stay of 12 days. There were four deaths observed in those who underwent conservative management, unrelated to development of pleural infection. <bold>Conclusion:</bold> In this small cohort, conservative management for small-to-moderate haemothoraces was a feasible option without development of pleural infection. Larger RCTs should be done with a view to better identify the indications for TTs in traumatic haemothoraces.