Traumatic haemothoraces are managed with large bore chest drains to reduce the risk of infection from blood in the sterile pleural space.1 The benefits or harms of invasive pleural interventions in a contemporary trauma population are unknown, and there is a lack of high-quality evidence to guide decision-making. A 2021 systematic review of observation versus chest drain in small haemothoraces could not produce a recommendation due to low-quality evidence in the two studies identified.2 One retrospective study (n=749) reported that 73% of traumatic haemothoraces were ‘small’ (less than 300 cc), which raises the possibility of spontaneous re-absorption without intervention.3 Furthermore, no cases of empyema were reported in the haemothoraces managed conservatively (n=258). Observational audit data could provide additional evidence in support of a high-quality definitive trial of observation versus chest drain in patients with traumatic haemothoraces.

In the UK trauma system, patients identified as having injuries consistent with ‘Major Trauma’ are diverted to major trauma centres (MTC) prior to ED arrival or …