Post-traumatic empyema thoracis in blunt chest trauma.

Three out of 42 patients who had isolated blunt chest injury requiring closed tube thoracostomy developed post-traumatic empyema thoracis. All of them were treated by thoracotomy and evacuation of the infected fluid with multiple chest tube drainage. Cultures of the pleural fluid grew Staphylococcus aureus in these 3 patients. Univariate analysis was performed by using Fisher's exact test which revealed the significance of age in association with the development of empyema thoracis. Multivariate analysis was performed by using Logistic Regression. Although no statistical significance was observed, the analysis revealed that the risk of empyema thoracis increased in elderly patients and in patients who had prolonged placement of thoracostomy tube. Intensive pulmonary care in elderly patients who sustained chest injury and early removal of thoracostomy tube is recommended in order to prevent the development of empyema thoracis.

Can unnecessary operations for abdominal stab would be safely reduced? A review of 255 patients.

Records of 255 patients who underwent laparotomies for stab wounds to the abdomen and lower chest were reviewed. Criteria for laparotomy were clinical and followed the conventional lines. Seventy-six patients (30%) were classified as having had an unnecessary laparotomy. Univariate analysis with the Chi-square test revealed 8 variables which differed significantly between the necessary and unnecessary laparotomy groups. Further stepwise discriminant analysis demonstrated 4 variables which had independent significance; they are the type of injury, generalized abdominal tenderness, haemoperitoneum and active intraabdominal bleeding. A mathematical model utilizing these 4 variables may be able to predict the need for laparotomy more accurately than utilizing any single variable. A prospective study is needed to test this hypothesis.