CClinicalTrials.gg
CompletedNCT03167723Updated Mar 29, 2023Results posted

Prospective Evaluation of 14F Thal Tube vs 28 French Chest Tube for Hemothorax and Use of Maximum Barrier Precautions

An interventional study of Chest tube placement in Hemothorax, Hemopneumothorax; Traumatic and Empyema, sponsored by Wake Forest University Health Sciences. Completed at 1 site in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2023-03-29.

Sponsored by Wake Forest University Health Sciences · Not applicable, Interventional, and Treatment

Phase
Not applicable
Study type
Interventional
Enrollment
193
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Study summary

Traumatic hemothorax and hemopneumothorax are common diagnoses which are typically treated by placement of a chest tube. 28-32 Fr chest tubes have previously been shown equivalent to 36-40 Fr chest tubes for the non-emergent drainage of hemothorax. A smaller study has found 14 Fr pigtails had less pain than larger tubes but was not powered to compare outcomes. We seek to perform a prospective randomized trial that is adequately powered comparing efficacy of 14 Fr thal tubes to 28 Fr chest tubes for non-emergent drainage of hemothorax and hemopneumothorax. Additionally, we will employ maximal barrier precautions for all chest tube insertions and compare empyema rates to our historical controls.

02

Conditions studied

  • Hemothorax
  • Hemopneumothorax; Traumatic
  • Empyema
  • Chest Tube Size

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Keywords

  • Chest tube size
  • Hemothorax
  • Empyema
03

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • The patient is admitted to the trauma service.
  • The patient has a hemothorax and/or or hemopneumothorax, requiring thoracostomy tube placement.
  • Thoracostomy tube placement is able to be performed or witnessed by an investigator listed on the study.
  • The patient has not had a chest tube in the past year.
  • The patient is >18 years of age.
  • In the event the patient is decisionally impaired, consent will be obtained from the individual's legally authorized representative (LAR) or from the individual's healthcare power of attorney (HPA).
  • In the instance of reversible impairment, initial consent would be obtained from the LAR/HPA and the patient will be approached for consent once he/she is deemed mentally competent by the care provider.

Exclusion criteria

Exclusion Criteria:

  • The patient is incarcerated
  • The patient is known to be pregnant
  • The patient is \< 18 years of age
  • The patient is hemodynamically unstable, requiring emergent chest tube placement (in \<10 minutes from evaluation).
04

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Single (Investigator)
Enrollment
193 participants (actual)

Study arms

  • Experimental
    28 French chest tube for hemothorax

    28 French straight chest tube placed for non-emergent drainage of hemothorax or hemopneumothorax

    Device: Chest tube placement

  • Experimental
    14 French chest tube for hemothorax

    14 French thal chest tube placed for non-emergent drainage of hemothorax or hemopneumothorax

    Device: Chest tube placement

Interventions

  • DeviceChest tube placement

    Placing tube thoracostomy for hemothorax or hemopneumothorax utilizing maximal barrier precautions.

05

What researchers measure

Primary outcomes

  1. Number of Participants With Retained Hemothorax Following Initial Chest Tube Placement Requiring Intervention

    Number of Participants with Retained hemothorax requiring an additional intervention, either video-assisted thoracoscopic surgery (VATS) or additional thoracostomy tube placement.

    Time frame: 90 days

Secondary outcomes

  1. Duration of Chest Tube Placement.

    Number of days with chest tube placement

    Time frame: 90 days

  2. Number of Participants Stratified by Length of Hospitalization Stay

    Number of weeks spent in hospital

    Time frame: 90 days

  3. Change in Subjective Pain Scores From Baseline at 90 Days

    Assessed with 0-10 numeric pain rating scale - the higher the number, the more severe the pain

    Time frame: 90 days

  4. Hemodynamic Stability Post-insertion

    determined by vital signs: temperature, heart rate, blood pressure, oxygen saturation (Systolic Blood Pressure \<90mm Hg)

    Time frame: 90 days

  5. Initial Drainage From Chest Tube at 5 Minutes

    Milliliters of chest tube drainage at 5 minutes

    Time frame: 5 Minutes

  6. Tube Specific Complications: Air Leak, Tube Malposition, & Tube Migration

    Number of Tube specific complications: Air leak, tube malposition, \& tube migration

    Time frame: 90 days

  7. Time to Radiographic Resolution of Pneumothorax/Hemothorax/Hemopneumothorax

    Number of days until radiographic resolution of pneumothorax/hemothorax/hemopneumothorax

    Time frame: 90 days

  8. Recurrent Pneumothorax/Hemothorax/Hemopneumothorax After Tube Removal

    Number of Participants with Recurrent pneumothorax/hemothorax/hemopneumothorax after tube removal

    Time frame: 90 days

  9. Readmission for Chest Tube Related Complications

    Number of Participants readmitted for chest tube related complications

    Time frame: 90 days

06

Results

Posted Mar 29, 2023

Participant flow

Participant flow — Overall Study
Milestone28 French Chest Tube for Hemothorax14 French Chest Tube for Hemothorax
Started5554
Completed5148
Not completed46
Withdrew: Protocol violation46

Outcome measures

PrimaryNumber of Participants With Retained Hemothorax Following Initial Chest Tube Placement Requiring Intervention

Number of Participants with Retained hemothorax requiring an additional intervention, either video-assisted thoracoscopic surgery (VATS) or additional thoracostomy tube placement.

Time frame:
90 days
Reported as:
Number · Number of Participants
Number of Participants With Retained Hemothorax Following Initial Chest Tube Placement Requiring Intervention
Number of Participants28 French Chest Tube for Hemothorax14 French Chest Tube for Hemothorax
Number of Participants With Retained Hemothorax Following Initial Chest Tube Placement Requiring Intervention5148
Statistical analysis
  • 28 French Chest Tube for Hemothorax vs 14 French Chest Tube for Hemothorax · Farrington-Manning · p = 0.036
SecondaryDuration of Chest Tube Placement.

Number of days with chest tube placement

Time frame:
90 days
Reported as:
Median · days
Duration of Chest Tube Placement.
days28 French Chest Tube for Hemothorax14 French Chest Tube for Hemothorax
Duration of Chest Tube Placement.3.9 (2.6 to 5.3)3.9 (2.8 to 5.8)
SecondaryNumber of Participants Stratified by Length of Hospitalization Stay

Number of weeks spent in hospital

Time frame:
90 days
Reported as:
Number · Number of Participants
Number of Participants Stratified by Length of Hospitalization Stay
Number of Participants28 French Chest Tube for Hemothorax14 French Chest Tube for Hemothorax
1 Week2015
2 Weeks1915
3 Weeks76
> or = 4 Weeks512
SecondaryChange in Subjective Pain Scores From Baseline at 90 Days

Assessed with 0-10 numeric pain rating scale - the higher the number, the more severe the pain

Time frame:
90 days
Reported as:
Median · units on a scale
Change in Subjective Pain Scores From Baseline at 90 Days
units on a scale28 French Chest Tube for Hemothorax14 French Chest Tube for Hemothorax
Change in Subjective Pain Scores From Baseline at 90 Days0 (-1 to 2)0 (-2 to 2)
SecondaryHemodynamic Stability Post-insertion

determined by vital signs: temperature, heart rate, blood pressure, oxygen saturation (Systolic Blood Pressure \<90mm Hg)

Time frame:
90 days
Reported as:
Number · Number of Participants
Hemodynamic Stability Post-insertion
Number of Participants28 French Chest Tube for Hemothorax14 French Chest Tube for Hemothorax
Hemodynamic Stability Post-insertion21
SecondaryInitial Drainage From Chest Tube at 5 Minutes

Milliliters of chest tube drainage at 5 minutes

Time frame:
5 Minutes
Reported as:
Median · mL
Initial Drainage From Chest Tube at 5 Minutes
mL28 French Chest Tube for Hemothorax14 French Chest Tube for Hemothorax
Initial Drainage From Chest Tube at 5 Minutes150 (60 to 500)100 (3.5 to 350)
SecondaryTube Specific Complications: Air Leak, Tube Malposition, & Tube Migration

Number of Tube specific complications: Air leak, tube malposition, \& tube migration

Time frame:
90 days
Reported as:
Number · Ocurrences
Tube Specific Complications: Air Leak, Tube Malposition, & Tube Migration
Ocurrences28 French Chest Tube for Hemothorax14 French Chest Tube for Hemothorax
Tube Specific Complications: Air Leak, Tube Malposition, & Tube Migration75
SecondaryTime to Radiographic Resolution of Pneumothorax/Hemothorax/Hemopneumothorax

Number of days until radiographic resolution of pneumothorax/hemothorax/hemopneumothorax

Time frame:
90 days
Reported as:
Median · days
Time to Radiographic Resolution of Pneumothorax/Hemothorax/Hemopneumothorax
days28 French Chest Tube for Hemothorax14 French Chest Tube for Hemothorax
Time to Radiographic Resolution of Pneumothorax/Hemothorax/Hemopneumothorax0.5 (0.1 to 2.7)1 (0.1 to 2.7)
SecondaryRecurrent Pneumothorax/Hemothorax/Hemopneumothorax After Tube Removal

Number of Participants with Recurrent pneumothorax/hemothorax/hemopneumothorax after tube removal

Time frame:
90 days
Reported as:
Number · participants
Recurrent Pneumothorax/Hemothorax/Hemopneumothorax After Tube Removal
participants28 French Chest Tube for Hemothorax14 French Chest Tube for Hemothorax
Recurrent Pneumothorax/Hemothorax/Hemopneumothorax After Tube Removal51
SecondaryReadmission for Chest Tube Related Complications

Number of Participants readmitted for chest tube related complications

Time frame:
90 days
Reported as:
Number · participants
Readmission for Chest Tube Related Complications
participants28 French Chest Tube for Hemothorax14 French Chest Tube for Hemothorax
Readmission for Chest Tube Related Complications94

Adverse events

Collected over 90 days. Non-serious events are listed at a 0% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
28 French Chest Tube for Hemothorax2/55 (3.6%)0/55 (0%)0/55 (0%)
14 French Chest Tube for Hemothorax2/54 (3.7%)0/54 (0%)0/54 (0%)

Baseline characteristics

Age, Continuous
Age, Continuous(years)28 French Chest Tube for Hemothorax14 French Chest Tube for HemothoraxTotal
Median49.9 (33.6 to 72.4)46.5 (26.8 to 68.6)49 (26.5 to 72)
Sex: Female, Male
Sex: Female, Male(Participants)28 French Chest Tube for Hemothorax14 French Chest Tube for HemothoraxTotal
Female171532
Male383977
Race and Ethnicity Not Collected
Race and Ethnicity Not Collected(Participants)28 French Chest Tube for Hemothorax14 French Chest Tube for HemothoraxTotal
Count of participants——0
Injury Severity Score - score that ranges from 3 (least) to 75 (most) injured
Injury Severity Score - score that ranges from 3 (least) to 75 (most) injured(units on a scale)28 French Chest Tube for Hemothorax14 French Chest Tube for HemothoraxTotal
Median17 (13 to 29)18 (10 to 29)17 (10 to 29)
07

Study locations

1 site
  • Carolinas Medical Center
    Charlotte, North Carolina 28203, United States
08

References and documents

Publications

  • Karmy-Jones R, Holevar M, Sullivan RJ, Fleisig A, Jurkovich GJ. Residual hemothorax after chest tube placement correlates with increased risk of empyema following traumatic injury. Can Respir J. 2008 Jul-Aug;15(5):255-8. doi: 10.1155/2008/918951. PubMed 18716687 ↗
  • Inaba K, Lustenberger T, Recinos G, Georgiou C, Velmahos GC, Brown C, Salim A, Demetriades D, Rhee P. Does size matter? A prospective analysis of 28-32 versus 36-40 French chest tube size in trauma. J Trauma Acute Care Surg. 2012 Feb;72(2):422-7. doi: 10.1097/TA.0b013e3182452444. PubMed 22327984 ↗
  • Kulvatunyou N, Erickson L, Vijayasekaran A, Gries L, Joseph B, Friese RF, O'Keeffe T, Tang AL, Wynne JL, Rhee P. Randomized clinical trial of pigtail catheter versus chest tube in injured patients with uncomplicated traumatic pneumothorax. Br J Surg. 2014 Jan;101(2):17-22. doi: 10.1002/bjs.9377. PubMed 24375295 ↗

Study documents

  • Protocol and statistical analysis plan · Oct 6, 2017
  • Informed consent form · Oct 12, 2017

Documents are hosted by the registry — open the source record to download them.

Individual participant data

Plan to share: No

09

Registry details

Key details

Study ID
NCT03167723
Lead sponsor
Wake Forest University Health Sciences
Responsible party
Sponsor
First posted
May 30, 2017
Start date
May 8, 2017
Primary completion
Dec 20, 2021
Completion
Dec 20, 2021
Results posted
Mar 29, 2023
Last update
Mar 29, 2023

Study contacts

Bradley W Thomas, MD
principal investigator · Wake Forest University Health Sciences

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
Yes
View the source record on ClinicalTrials.gov ↗

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