Written by Millie Cossé
Spoon Feed
Pigtail catheters had a similar safety profile and rates of catheter failures compared to chest tubes for treatment of hemodynamically stable children with hemothorax or hemopneumothorax.
Go big or go home?
There is a growing body of evidence to support the safe and effective use of pigtail catheters for hemothorax (HTX) and hemopneumothorax (HPTX) drainage in adults, but pediatric data are lacking.
This retrospective study of 548 hemodynamically stable pediatric patients with HTX or HTPX conducted across numerous trauma centers evaluated catheter failure rate (requirement for surgery, additional tube placement, or thrombolytics for retained HTX) as well as complication rate among patients who underwent tube thoracostomy with either a chest tube (CT) or pigtail catheter (PC).
Failure rate was similar for CT versus PC (17.6% vs. 12.6%, p=0.38), as was the complication rate after multivariable analysis to reduce confounding (OR 1.05, 95%CI 0.95-1.15, p=0.3). With univariate analysis, the complication rate for PC was slightly higher, but that was primarily driven by increased frequency of ventilator-associated pneumonia, which is physiologically unrelated to the size of chest tube.
Importantly, patients who were hemodynamically unstable at the time of tube thoracostomy placement were excluded from this analysis (535 of 1087 patients initially entered were excluded due to hemodynamic instability). The authors explain that they do not feel the patient groups are comparable in terms of disease process, and wonder if PCs may not be readily available or appropriate for unstable patients who require finger thoracostomy.
How will this change my practice?
There seems to be a clear trend in the literature that pigtail catheters are safe and effective for HTX drainage. I plan to use PCs for treatment of HTX in adults and children whenever possible.
Source
Percutaneous pigtail catheter versus chest tube for the treatment of pediatric traumatic hemothorax: An Eastern Association for the Surgery of Trauma multicenter study. J Trauma Acute Care Surg. 2025 Dec 1;99(6):850-858. doi: 10.1097/TA.0000000000004775. Epub 2025 Sep 15. PMID: 40956282.
View JournalFeed Critical Appraisal
Critical Appraisal
Study Identification
Background
Study Question
Study Design & Conduct
Prospective / Retrospective: Retrospective
Multicenter: Yes
Unit of Allocation: Not applicable
Unit of Analysis: Patients
Randomization Method: Not applicable
Allocation Concealment: Not applicable
Blinding: Not applicable
Follow-up Duration: Not reported
Population
- Pediatric trauma patients younger than 18 years
- Diagnosed with hemothorax or hemopneumothorax
- Pneumothorax without hemothorax component
- Underwent emergency department thoracotomy
- Hemodynamically unstable at time of tube placement
- Missing data on age or catheter type
Number Enrolled: 548
Number Analyzed: 548
Key Baseline Characteristics
Sex: 79.2% male in CT group, 78.8% male in PC group
Disease Severity: ISS: CT 17, PC 16
Care Setting Distribution: 41 trauma centers
Additional Baseline Characteristics
- Higher rate of penetrating trauma in CT group
- Pigtail catheter usage increased over study years
Exposures / Interventions
Description: Percutaneous pigtail catheter
Definition / Dose: 14 Fr or smaller
Timing: At time of hemothorax diagnosis
Classification Method: Chart review and trauma registry codes
Protocolized / Discretionary: Discretionary
Description: Traditional chest tube
Definition: Standard chest tube placement
Outcomes & Results
Primary Outcomes
Definition: Requirement for surgery, additional tube placement, or thrombolytics
Time Point: Not reported
Measurement Method: Clinical assessment and chart review
Results: CT 17.6% vs. PC 12.6%, p=0.38
Secondary Outcomes
Definition: Respiratory distress, effusion, empyema, pneumonia, infection, deep venous thrombosis
Time Point: Not reported
Measurement Method: Clinical assessment and chart review
Results: CT 11.9% vs. PC 19.7%, p=0.02; Adjusted OR 1.05, 95% CI 0.95–1.15, p=0.3
Risk of Bias
Risk of Bias - ROBINS-I
- Bias due to confounding (Some concerns): Retrospective design with potential unrecognized confounders despite multivariable adjustment.
- Bias in selection of participants (Low): Participants selected from trauma registries with clear inclusion criteria.
- Bias in classification of interventions (Low): Interventions clearly defined as pigtail catheter or chest tube.
- Bias due to deviations from intended interventions (Low): Interventions were standard clinical practices with no deviations reported.
- Bias due to missing data (Some concerns): Some missing data on drainage volumes and ventilator days, but primary outcome data were complete.
- Bias in measurement of outcomes (Low): Outcomes were clearly defined and measured consistently across centers.
- Bias in selection of the reported result (Low): All relevant outcomes were reported with appropriate statistical analyses.
Transparency
COI Statement Present: TRUE
