Systemic Injury Burden, Not Pneumothorax Size, Predicts Prolonged Chest Tube Duration in Traumatic Pneumothorax: A Retrospective Analysis at a Level 1 Trauma Center

Prolonged chest tube (CT) duration in traumatic pneumothorax (PTX) is associated with increased complications and greater patient discomfort. This retrospective study characterized clinical and procedural factors associated with prolonged CT duration (>48 hours) in adult patients presenting at a level I trauma center undergoing tube thoracostomy for traumatic PTX between January 2020 and June 2023. Among 203 patients (mean age 46 years; 75% male; 86.7% blunt trauma), the mean CT duration was 77.6 hours. There was no significant difference in initial PTX size between patients who had a normal CT duration and patients who had prolonged CT duration. Prolonged CT duration occurred more frequently with open CT, bilateral CT, ICU admission, mechanical ventilation, supplemental oxygen on arrival, and longer hospital stay. Chest tube duration correlated significantly with higher injury severity score (ISS), higher chest AIS, larger tube size, lower presenting blood pressure, and higher heart rate. These findings suggest that systemic injury burden, rather than PTX characteristics like size, identifies patients likely to require prolonged CT duration.