{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T12:10:41Z","timestamp":1790079041125,"version":"4.0.1"},"reference-count":27,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T00:00:00Z","timestamp":1789776000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: Tube thoracostomy is performed by several specialties in several hospital settings, but institution-wide data comparing who performs the procedure, where, how, and with what complications are limited. Methods: In this retrospective observational cohort study, all tube thoracostomies performed over a three-year period at a tertiary university hospital were identified through the hospital information system. Procedures were grouped by performing team (emergency medicine, thoracic surgery, and intensive care) and by setting (emergency department [ED], operating room\/ward, and intensive care unit [ICU]) and compared with respect to demographics, indications, operator seniority, anesthesia practice, chest tube size, and complications. Effect sizes are reported with 95% confidence intervals (CIs), and predictors of complications were examined in a multivariable binomial logistic regression model. Results: In total, 487 procedures were analyzed (76.0% male; median age 56 years). The emergency medicine team performed 47.2% of procedures (all in the ED), the thoracic surgery team 46.8% (the only team active in all three settings), and the intensive care team 6.0%. Indication profiles diverged (p &lt; 0.001): traumatic (34.8%) and spontaneous pneumothorax (31.7%) dominated the emergency medicine caseload, pleural effusion (40.4%) the thoracic surgery caseload, and iatrogenic pneumothorax (72.4%) the intensive care caseload. Overall, 95.9% of tubes were 28 F or 32 F; the thoracic surgery team favored 32 F (75.9%; p &lt; 0.001). First-year residents performed 39.8% of procedures, two-thirds of them on the thoracic surgery team. Complications occurred in 70 procedures (14.4%), 90.0% of which were tube malpositions. Crude complication rates were 10.0% for emergency medicine, 16.2% for thoracic surgery, and 34.5% for intensive care (p = 0.001), but rates rose with the acuity of the setting (ED 10.9%, ICU 26.8%) and within-setting differences between teams were not significant (ED p = 0.363; ICU p = 0.301). In a multivariable model adjusting for team, setting, age, indication group and operator seniority, neither team (p = 0.164) nor setting (p = 0.223) was independently associated with complications. Complication rates did not differ by postgraduate year (16.5%, 9.8%, 14.3% and 20.8% for years 0\u20131 to 3\u20134; p = 0.157, test for trend p = 0.738), by tube size (\u226428 F 12.0% versus \u226532 F 15.8%; p = 0.287) or by age (p = 0.276). Conclusions: This hospital-wide map of procedural labor shows that the three teams served largely distinct patient populations. Team, setting and indication are so tightly linked in this hospital that no independent effect of specialty could be demonstrated in either direction. Operator seniority and tube size were not associated with complications. Malposition accounted for nine of every ten complications, which supports routine verification of tube position after insertion. Which team drains which pathology, where, and at what level of training is determined locally rather than by specialty training standards, and that map is the principal contribution of this series.<\/jats:p>","DOI":"10.3390\/jcm15187292","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T11:09:35Z","timestamp":1790075375000},"page":"7292","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Tube Thoracostomy Across Emergency Medicine, Thoracic Surgery, and Intensive Care Residents: A Three-Year Retrospective Analysis of Practice Patterns and Complications at a Tertiary University Hospital"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9707-3315","authenticated-orcid":false,"given":"Emre","family":"\u015eanc\u0131","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Izmir Bakircay University Cigli Training and Research Hospital, Izmir 35620, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"given":"R\u0131dvan","family":"Atilla","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, European University of Lefka, Mersin 99010, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7908-6422","authenticated-orcid":false,"given":"Sefer","family":"\u00d6zg\u00fcr","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Izmir University of Economics, Izmir 35330, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9281-2978","authenticated-orcid":false,"given":"Hamza","family":"\u00c7\u0131ld\u0131r","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Buca Seyfi Demirsoy Training and Research Hospital, Izmir 35370, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"256878","DOI":"10.1155\/2012\/256878","article-title":"Tube thoracostomy: Complications and its management","volume":"2012","author":"Kesieme","year":"2012","journal-title":"Pulm. Med."},{"key":"ref_2","unstructured":"American College of Surgeons Committee on Trauma (2018). Advanced Trauma Life Support (ATLS) Student Course Manual, American College of Surgeons. [10th ed.]."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"ii61","DOI":"10.1136\/thx.2010.137026","article-title":"Pleural procedures and thoracic ultrasound: British Thoracic Society pleural disease guideline 2010","volume":"65","author":"Havelock","year":"2010","journal-title":"Thorax"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1097\/TA.0000000000001840","article-title":"Complications in tube thoracostomy: Systematic review and meta-analysis","volume":"85","author":"Hernandez","year":"2018","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1136\/emj.17.2.111","article-title":"Complications of tube thoracostomy in trauma","volume":"17","author":"Bailey","year":"2000","journal-title":"J. Accid. Emerg. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1001\/archsurg.1995.01430050071012","article-title":"Tube thoracostomy. Factors related to complications","volume":"130","author":"Etoch","year":"1995","journal-title":"Arch. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1016\/S1010-7940(02)00478-5","article-title":"Morbidity of percutaneous tube thoracostomy in trauma patients","volume":"22","author":"Deneuville","year":"2002","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_8","first-page":"450","article-title":"Chest tube complications: How well are we training our residents?","volume":"50","author":"Ball","year":"2007","journal-title":"Can. J. Surg."},{"key":"ref_9","first-page":"e33","article-title":"Comparing the quality and complications of tube thoracostomy by emergency medicine and surgery residents; a cohort study","volume":"5","author":"Kashani","year":"2017","journal-title":"Emergency"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"25","DOI":"10.5152\/TurkThoracJ.2018.18056","article-title":"An analysis of patients who underwent tube thoracostomy in the emergency department: A single center study","volume":"20","author":"Kantar","year":"2019","journal-title":"Turk. Thorac. J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1016\/S0735-6757(97)90127-3","article-title":"Complication rates of tube thoracostomy","volume":"15","author":"Chan","year":"1997","journal-title":"Am. J. Emerg. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.1016\/S0895-4356(96)00236-3","article-title":"A simulation study of the number of events per variable in logistic regression analysis","volume":"49","author":"Peduzzi","year":"1996","journal-title":"J. Clin. Epidemiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1136\/bmj.311.7003.485","article-title":"Statistics notes: Absence of evidence is not evidence of absence","volume":"311","author":"Altman","year":"1995","journal-title":"BMJ"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.jemermed.2008.06.033","article-title":"Complications of tube thoracostomy placement in the emergency department","volume":"40","author":"Sethuraman","year":"2011","journal-title":"J. Emerg. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2251","DOI":"10.1007\/s11739-025-04148-2","article-title":"Incidence and predictors of complications of tube thoracostomy performed in the emergency department for non-traumatic pleural pathologies","volume":"21","author":"Rossetto","year":"2025","journal-title":"Intern. Emerg. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1148\/radiology.195.2.7724780","article-title":"Complications after emergency tube thoracostomy: Assessment with CT","volume":"195","author":"Baldt","year":"1995","journal-title":"Radiology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.1097\/01.anes.0000267594.80368.01","article-title":"Incidence of chest tube malposition in the critically ill: A prospective computed tomography study","volume":"106","author":"Luce","year":"2007","journal-title":"Anesthesiology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1007\/s00068-018-0966-z","article-title":"Clinical consequences of chest tube malposition in trauma resuscitation: Single-center experience","volume":"45","author":"Struck","year":"2019","journal-title":"Eur. J. Trauma Emerg. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/j.clinimag.2005.06.032","article-title":"Diagnosis of malpositioned chest tubes after emergency tube thoracostomy: Is computed tomography more accurate than chest radiograph?","volume":"29","author":"Lim","year":"2005","journal-title":"Clin. Imaging"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.injury.2011.06.420","article-title":"Complications following thoracic trauma managed with tube thoracostomy","volume":"43","author":"Menger","year":"2012","journal-title":"Injury"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1016\/j.amjsurg.2021.04.008","article-title":"Beyond the tube: Can we reduce chest tube complications in trauma patients?","volume":"222","author":"Platnick","year":"2021","journal-title":"Am. J. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"s43","DOI":"10.1136\/thorax-2022-219371","article-title":"British Thoracic Society clinical statement on pleural procedures","volume":"78","author":"Asciak","year":"2023","journal-title":"Thorax"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1097\/TA.0b013e3182452444","article-title":"Does size matter? A prospective analysis of 28\u201332 versus 36\u201340 French chest tube size in trauma","volume":"72","author":"Inaba","year":"2012","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1002\/bjs.9377","article-title":"Randomized clinical trial of pigtail catheter versus chest tube in injured patients with uncomplicated traumatic pneumothorax","volume":"101","author":"Kulvatunyou","year":"2014","journal-title":"Br. J. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.1016\/j.chest.2018.01.048","article-title":"A systematic review and meta-analysis comparing pigtail catheter and chest tube as the initial treatment for pneumothorax","volume":"153","author":"Chang","year":"2018","journal-title":"Chest"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1097\/TA.0000000000004412","article-title":"Small versus large-bore thoracostomy for traumatic hemothorax: A systematic review and meta-analysis","volume":"97","author":"Lyons","year":"2024","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"s1","DOI":"10.1136\/thorax-2022-219784","article-title":"British Thoracic Society guideline for pleural disease","volume":"78","author":"Roberts","year":"2023","journal-title":"Thorax"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/18\/7292\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T11:31:31Z","timestamp":1790076691000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/18\/7292"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,19]]},"references-count":27,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jcm15187292"],"URL":"https:\/\/doi.org\/10.3390\/jcm15187292","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,19]]}}}