Presumptive antibiotic use in tube thoracostomy for traumatic hemopneumothorax: an Eastern Association for the Surgery of Trauma practice management guideline
Guideline Developer(s)
Eastern Association for the Surgery of Trauma
Date Released
Full Text Guideline
Evidence Supporting the Recommendations
Current evidence (Class I-III) was considered insufficient to make a recommendation.
Implementation of the Guideline
An implementation strategy was not provided.
Benefits/Harms of Implementing the Guideline Recommendations
Appropriate management and treatment of individuals with traumatic hemopneumothorax undergoing chest tube insertion (tube thoracostomy [TT]) resulting in:
- Reduction in the occurrence of infectious complications such as empyema and pneumonia in patients who undergo TT for traumatic hemopneumothorax
- Decreased length of hospital stay, cost and morbidity to the patient
Inappropriate use of antibiotics and the increased incidence of multidrug-resistant organisms
Rating Scheme for the Strength of the Recommendations
Level I: The recommendation is convincingly justifiable based on the available scientific information alone. It is usually based on Class I data, however, strong Class II evidence may form the basis for a Level 1 recommendation, especially if the issue does not lend itself to testing in a randomized format. Conversely, low quality or contradictory Class I data may not be able to support a Level 1 recommendation.
Level II: The recommendation is reasonably justifiable by available scientific evidence and strongly supported by expert opinion. It is usually supported by Class II data or a preponderance of Class III evidence.
Level III: The recommendation is supported by available data but adequate scientific evidence is lacking. This recommendation is generally supported by Class III data. This type of recommendation is useful for educational purposes and in guiding future clinical research.
Qualifying Statements
- The Eastern Association for the Surgery of Trauma (EAST) is a multi-disciplinary professional society committed to improving the care of injured patients. The Ad hoc Committee for Practice Management Guideline Development of EAST develops and disseminates evidence-based information to increase the scientific knowledge needed to enhance patient and clinical decision-making, improve health care quality, and promote efficiency in the organization of public and private systems of health care delivery. Unless specifically stated otherwise, the opinions expressed and statements made in this publication reflect the authors' personal observations and do not imply endorsement by nor official policy of the Eastern Association for the Surgery of Trauma.
- "Clinical practice guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances."* These guidelines are not fixed protocols that must be followed, but are intended for health care professionals and providers to consider. While they identify and describe generally recommended courses of intervention, they are not presented as a substitute for the advice of a physician or other knowledgeable health care professional or provider. Individual patients may require different treatments from those specified in a given guideline. Guidelines are not entirely inclusive or exclusive of all methods of reasonable care that can obtain/produce the same results. While guidelines can be written that take into account variations in clinical settings, resources, or common patient characteristics, they cannot address the unique needs of each patient nor the combination of resources available to a particular community or health care professional or provider. Deviations from clinical practice guidelines may be justified by individual circumstances. Thus, guidelines must be applied based on individual patient needs using professional judgment.
*Institute of Medicine. Clinical practice guidelines: directions for a new program. MJ Field and KN Lohr (eds) Washington, DC: National Academy Press. 1990: pg 39.
Methodology
Hand-searches of Published Literature (Secondary Sources)
Searches of Electronic Databases
A computerized search of the National Library of Medicine MEDLINE database was undertaken using the PubMed Entrez interface. English language citations for the period of 1997 through 2011 were included, focusing on presumptive or prophylactic antibiotic use in tube thoracostomy (TT) for traumatic hemopneumothorax. Review articles, letters to the editor, and case reports were excluded from the search. The dates selected allowed for minimal overlap since the last published guidelines. In addition, the bibliographies of each article were reviewed for references not originally identified by the MEDLINE search.
Of the 98 articles identified by both methods, seven were prospective or retrospective and selected as meeting criteria for review.
Weighting According to a Rating Scheme (Scheme Given)
Class I: Prospective randomized controlled trials.
Class II: Clinical studies in which data were collected prospectively or retrospective analyses based on clearly reliable data, such as cohort, observational, prevalence, or case-control studies.
Class III: Studies based on retrospectively collected data, including database or registry review, case series, or expert opinion.
Review of Published Meta-Analyses
Systematic Review with Evidence Tables
Articles were classified according to the Eastern Association for the Surgery of Trauma (EAST) primer "Utilizing Evidence-Based Outcome Measures to Develop Practice Management Guidelines" (see the "Availability of Companion Documents" field).
Articles were classified as Class I, II, or III according to the definitions described in the "Rating Scheme for the Strength of the Evidence" field.
Expert Consensus
The Practice Management Guidelines Committee Work Group for Presumptive Antibiotics in Tube Thoracostomy (TT) for Traumatic Hemopneumothorax consisted of 10 acute care surgeons and one statistician/epidemiologist who reviewed the articles and collaborated to produce the practice management guideline document.
Recommendations were generated according to the Eastern Association for the Surgery of Trauma (EAST) primer "Utilizing Evidence-Based Outcome Measures to Develop Practice Management Guidelines" (see the "Availability of Companion Documents" field).
Recommendations were then classified as Level 1, 2, or 3 according to the definitions described in the "Rating Scheme for the Strength of the Recommendations" field.
A formal cost analysis was not performed and published cost analyses were not reviewed.
Not stated
Not applicable
Identifying Information and Availability
Moore FO, Duane TM, Hu CK, Fox AD, McQuay N Jr, Lieber ML, Como JJ, Haut ER, Kerwin AJ, Guillamondegui OD, Burns JB, Eastern Association for the Surgery of Trauma. Presumptive antibiotic use in tube thoracostomy for traumatic hemopneumothorax: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012 Nov;73(5 Suppl 4):S341-4. [20 references] PubMed
Not applicable: The guideline was not adapted from another source.
Eastern Association for the Surgery of Trauma (EAST)
Eastern Association for the Surgery of Trauma (EAST) Practice Management Guidelines Committee
Committee Members: Forrest O. Moore, MD; Therese M. Duane, MD; Charles K.C. Hu, MD; Adam D. Fox, DO; Nathaniel McQuay, Jr., MD; Michael L. Lieber, MS; John J. Como, MD; Elliott R. Haut, MD; Andrew J. Kerwin, MD; Oscar D. Guillamondegui, MD; J. Bracken Burns, DO
Elliot R. Haut (E.R.H.) is the Principal Investigator (PI) of a Mentored Clinical Scientist Development Award K08 1K08HS017952-01 from the Agency for Healthcare Research and Quality (AHRQ) entitled "Does Screening Variability Make DVT an Unreliable Quality Measure of Trauma Care?" E.R.H. receives royalties from Lippincott, Williams, Wilkins for a book - "Avoiding Common ICU Errors." E.R.H. has given expert witness testimony in various medical malpractice cases. The authors declare no conflicts of interest.
This is the current release of the guideline.
This guideline updates a previous version:
Luchette FA, Barrie PS, Oswanski MF, Spain DA, Mullins CD, Palumbo F, Pasquale MD. Practice management guidelines for prophylactic antibiotic use in tube thoracostomy for traumatic hemopneumothorax. J Trauma 2000 Apr;48(4):753-7. [26 references]
Practice management guidelines for prophylactic antibiotic use in tube thoracostomy for traumatic hemopneumothorax. Allentown (PA): Eastern Association for the Surgery of Trauma (EAST); 2000. 16 p. [26 references]
Electronic copies: Available in Portable Document Format (PDF) format from the Eastern Association for the Surgery of Trauma (EAST) Web site.
Print copies: Available from the EAST Guidelines, c/o Forrest O. Moore, MD, Division of Trauma & Surgical Critical Care, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA 71130; email: moore677@aol.com.
The following is available:
- Utilizing evidence based outcome measures to develop practice management guidelines: a primer. Allentown (PA): Eastern Association for the Surgery of Trauma; 2000. 18 p. Available in Portable Document Format (PDF) from the Eastern Association for the Surgery of Trauma (EAST) Web site.
None available
This NGC summary was completed by ECRI on March 9, 2001. The information was verified by the guideline developer on May 4, 2001. This NGC summary was updated by ECRI on April 12, 2013. The updated information was verified by the guideline developer on May 10, 2013.
This NGC summary is based on the original guideline, which is copyrighted by the Eastern Association for the Surgery of Trauma (EAST).
Scope
Traumatic hemopneumothorax
Management
Prevention
Critical Care
Emergency Medicine
Pulmonary Medicine
Surgery
Thoracic Surgery
Advanced Practice Nurses
Allied Health Personnel
Nurses
Physician Assistants
Physicians
- To develop updated recommendations from the 1998 original guideline document on the use of presumptive antibiotics in tube thoracostomy (TT) for patients who sustained a traumatic hemopneumothorax
- To address the clinical questions:
- Do presumptive antibiotics reduce the incidence of empyema or pneumonia?
- If presumptive antibiotics reduce the incidence of empyema or pneumonia, what is the optimal duration of antibiotic prophylaxis?
Individuals with traumatic hemopneumothorax undergoing chest tube insertion (tube thoracostomy [TT])
Tube thoracostomy with and without presumptive antibiotics
Incidence of:
- Pneumonia
- Empyema
Recommendations
Do presumptive antibiotics reduce the incidence of empyema or pneumonia in tube thoracostomy (TT) for traumatic hemopneumothorax?
- There is insufficient published evidence to support any recommendation either for or against the use of presumptive antibiotics to reduce the incidence of empyema or pneumonia in TT for traumatic hemopneumothorax.
None provided
Institute of Medicine (IOM) National Healthcare Quality Report Categories
Getting Better
Staying Healthy
Effectiveness
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