Incidence and predictors of complications of tube thoracostomy performed in the emergency department for non-traumatic pleural pathologies

Tube thoracostomy (TT) is a common emergency procedure for the management of non-traumatic pleural conditions in the emergency department (ED). While effective, it carries a significant risk of complications. We aimed to assess the incidence and predictors of complications associated with TT performed in the ED for non-traumatic pleural pathologies. Retrospective cohort study involving adult patients undergoing TT in the ED of a University Hospital between 2020 and 2023 in Italy. Multivariable logistic regression was used to identify independent risk factors for complications. We enrolled 293 adult patients who underwent TT in the ED. Of these, 40% (116/293) were female, and the median age was 70 years (50-78). A pleural effusion was diagnosed in 67% (197/293) of patients, 11% (20/197) of whom had a loculated effusion, whereas a pneumothorax in 43% (126/293). TT-related complications occurred in 24% of cases, with malposition/dislodgment (13%), pneumothorax (9%) and obstruction (5%) most frequent. No deaths were directly attributed to TT. Multivariable analysis identified higher platelet counts (OR 1.39, 95%CI 1.02-1.89, p = 0.035) and localized pleural disease (OR 1.44, 95%CI 1.09-1.90, p = 0.011) as independent risk factors. No significant association was found with operator specialty, seniority, drain type, or time of procedure. TT performed in the ED for non-traumatic pleural diseases is associated with a complication rate comparable to other settings. Complicated pleural pathology and elevated platelet count were the main predictors of adverse events.