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Recent evidence has begun to challenge the use of large-bore surgical chest drains in the management of traumatic haemopneumothorax. Large-bore surgical drains are considered those >24F in diameter (requiring blunt dissection for insertion) while smaller drains (using a Seldinger needle over-wire technique) are those varying in size from <14F up to 20F.1 2 It has been reported that small-bore drains are more likely to be malpositioned and complicated by pneumonia, whereas large-bore drains have a higher risk of an additional pleural procedure and empyema. Based on largely retrospective data, the 2021 Eastern Association for the Surgery in Trauma management guideline conditionally recommended small-bore drains for stable patients with an isolated haemothorax.3 Subsequently, a small, randomised controlled trial (RCT) (n=119) of stable patients with isolated haemothorax reported that smaller drains are as effective as bigger drains for treating a haemothorax, with …
Handling editor Jason E Smith
Twitter @jamesfoley273, @DrsteveWalker, @EddCarlton
Contributors JF: Survey distribution, writing and data analysis. SW: Case vignette and image consultation, and survey design. EC: Survey conceptualisation and survey distribution.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.