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Émond M, Guimont C, Chauny JM, et al. Clinical prediction rule for delayed hemothorax after minor thoracic injury: a multicentre derivation and validation study. CMAJ Open. 2017;5(2):E444-E453doi: 10.9778/cmajo.20160096.
Émond, M., Guimont, C., Chauny, J. M., Daoust, R., Bergeron, �. �., Vanier, L., Moore, L., Plourde, M., Kuimi, B., Boucher, V., Allain-Boulé, N., & Le Sage, N. (2017). Clinical prediction rule for delayed hemothorax after minor thoracic injury: a multicentre derivation and validation study. CMAJ open, 5(2), E444-E453. https://doi.org/10.9778/cmajo.20160096
Émond, Marcel, et al. "Clinical prediction rule for delayed hemothorax after minor thoracic injury: a multicentre derivation and validation study." CMAJ open vol. 5,2 (2017): E444-E453. doi: https://doi.org/10.9778/cmajo.20160096
Émond M, Guimont C, Chauny JM, Daoust R, Bergeron É, Vanier L, Moore L, Plourde M, Kuimi B, Boucher V, Allain-Boulé N, Le Sage N. Clinical prediction rule for delayed hemothorax after minor thoracic injury: a multicentre derivation and validation study. CMAJ Open. 2017 Jun 12;5(2):E444-E453. doi: 10.9778/cmajo.20160096. PMID: 28611156; PMCID: PMC5498437.
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CMAJ Open. 2017 Jun 12;5(2):E444-E453. doi: 10.9778/cmajo.20160096.

Clinical prediction rule for delayed hemothorax after minor thoracic injury: a multicentre derivation and validation study.

CMAJ open

Marcel Émond, Chantal Guimont, Jean-Marc Chauny, Raoul Daoust, Éric Bergeron, Laurent Vanier, Lynne Moore, Miville Plourde, Batomen Kuimi, Valérie Boucher, Nadine Allain-Boulé, Natalie Le Sage

Affiliations

  1. Affiliations: Centre hospitalier universitaire de Québec, Université Laval (Émond, Guimont, Plourde Moore, Kuimi, Boucher, Allain-Boulé, Le Sage); Université Laval (Émond, Guimont, Plourde, Boucher, Allain-Boulé, Le Sage), Laval, Que.; Centre d'excellence sur le vieillissement de Québec (Émond, Boucher), Québec, Que.; Hôpital du Sacré-Coeur de Montréal (Chauny, Daoust); Département de médecine familiale et médecine d'urgence (Chauny, Daoust), Université de Montréal, Montréal, Que.; Centre hospitalier de Charles-LeMoyne (Bergeron, Vanier), Greenfield Park, Que.

PMID: 28611156 PMCID: PMC5498437 DOI: 10.9778/cmajo.20160096

Abstract

BACKGROUND: About 75% of patients with minor thoracic injury are discharged after an emergency department visit. However, complications such as delayed hemothorax can occur. We sought to derive and validate a clinical decision rule to predict hemothorax in patients discharged from the emergency department.

METHODS: We conducted a 6-year prospective cohort study in 4 university-affiliated emergency departments. Patients aged 16 years or older presenting with a minor thoracic injury were assessed at 5 time points (initial visit and 7, 14, 30 and 90 d after the injury). Radiologists' reports were reviewed for the presence of hemothorax. We used log-binomial regression models to identify predictors of hemothorax.

RESULTS: A total of 1382 patients were included: 830 in the derivation phase and 552 in the validation phase. Of these, 151 (10.9%) had hemothorax at the 14-day follow-up. Patients 65 years of age or older represented 25.3% (210/830) and 23.7% (131/552) of the derivation and validation cohorts, respectively. The final clinical decision rule included a combination of age (> 70 yr, 2 points; 45-70 yr, 1 point), fracture of any high to mid thorax rib (ribs 3-9, 2 points) and presence of 3 or more rib fractures (1 point). Twenty (30.8%) of the 65 high-risk patients (score ≥ 4) experienced hemothorax during the follow-up period. The clinical decision rule had a high specificity (90.7%, 95% confidence interval 87.7%-93.1%) in this high-risk group, thus guiding appropriate post-emergency care.

INTERPRETATION: One patient out of every 10 presented with delayed hemothorax after discharge from the emergency department. Implementation of this validated clinical decision rule for minor thoracic injury could guide emergency discharge plans.

Copyright 2017, Joule Inc. or its licensors.

Conflict of interest statement

Competing interests: None declared.

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