Systematic Review and Meta-Analysis of Pigtail Catheter Use in Traumatic Pneumothorax and Hemothorax
Published on: 2018-10-15
Background: Traumatic hemothorax and pneumothorax are common injuries for which conventional treatment is large bore chest tube placement. Increasingly, small bore pigtail catheters are used to treat non-traumatic pneumothorax and pleural effusions, however they have not been widely adopted for trauma. The objective of this systematic review is to examine the evidence behind pigtail catheter use in traumatic and iatrogenic hemothorax and pneumothorax. Methods: We searched PubMed and Embase databases and selected all studies that examined the use of pigtail catheters in traumatic or iatrogenic hemothorax or pneumothorax. Pediatric studies were excluded. We evaluated the quality of each study using GRADE criteria. A meta-analysis was completed to compare the success rate of pigtail catheter placement for traumatic or iatrogenic pneumothoraces. Many of the studies did not have a comparison group rendering the data insufficient to analyze chest tube success rates. Data on other endpoints were too heterogeneous to synthesize quantitatively. Results: We identified two studies of pigtail catheter use in traumatic hemothorax, two studies in traumatic pneumothorax, and four studies in iatrogenic pneumothorax. Success rates with a pigtail catheter ranged from 92% to 100% for traumatic hemothorax, 89% to 95% for traumatic pneumothorax, and 71% to 88% for iatrogenic pneumothorax. Our meta-analysis yielded a pooled success rate of 85% for pigtail catheters treating iatrogenic and traumatic pneumothorax. Conclusion: The use of pigtail catheters in trauma is promising, but the current literature is insufficient to support their use. Further study is warranted, and a large randomized controlled trial would be beneficial.