Outcomes of conservative management of CT-diagnosed hemothorax in chest trauma: A systematic review and meta-analysis.

Abstract

Hemothorax is one of the most common findings in traumatic chest injuries. Emerging evidence suggests that small-volume hemothoraces (less than 300 cc) diagnosed by CT scan can often be managed successfully with conservative (non-interventional) treatment. This choice is clinically important, as chest tube drainage may itself lead to complications. The aim was to evaluate the outcomes and complications of conservative management in patients with small-volume hemothorax. This systematic review and meta-analysis followed PRISMA guidelines. We searched PubMed, Scopus, and the Cochrane Library for studies on CT-diagnosed traumatic hemothorax in stable patients managed conservatively. Articles meeting the inclusion criteria were reviewed. The main outcome measured was the failure rate of conservative management. Of 3089 articles screened, 10 studies met inclusion criteria, reporting on 3030 patients with CT-diagnosed hemothorax. Among these, 1679 patients (55.4%) were managed conservatively, achieving an 81% success rate. Most cases (94.4%) involved a hemothorax volume under 300 cc, and 409 patients had an associated occult pneumothorax. Delayed tube thoracostomy was needed in 19% (319/1679) of conservatively managed patients; only 1.8% required further surgical intervention. The primary indications for delayed tube thoracostomy were progression of hemothorax on follow-up chest x-ray (62.0%), worsening pneumothorax (16.4%), and development of respiratory distress (12.3%). All reported mortality was unrelated to thoracic injuries. Patients with CT-diagnosed hemothorax < 300 cc (thickness <15 mm) can be managed conservatively, with 1 in 5 requiring later intervention. These results support observation in stable patients and highlight the need for careful monitoring and standardized protocols. However, these findings should be interpreted with caution, as prospective, high-quality clinical trials with standardized definitions, imaging criteria, and outcomes are needed before firm clinical recommendations can be made, to strengthen the current evidence base.