Pediatric Emergency Tube Thoracostomy: Complications and Independent Risk Factors in a Five-Year Cohort

Objectives: Tube thoracostomy is a frequently performed emergency procedure in pediatric patients; however, complication patterns and risk stratification in emergency settings remain incompletely defined. This study aimed to evaluate 30-day complication rates and identify independent predictors of adverse outcomes in pediatric patients undergoing tube thoracostomy in emergency settings.
Methods: This retrospective observational cohort study included 451 consecutive pediatric patients (0–18 years) who underwent tube thoracostomy between June 2020 and June 2025 at a tertiary referral center. Emergency settings included procedures performed in the Emergency Department (ED), Pediatric Intensive Care Unit (PICU), or urgent perioperative settings. The primary outcome was 30-day procedure-related complications. Variables with p<0.10 in univariate analysis were entered into a multivariate logistic regression model to determine independent predictors. Model calibration and discrimination were assessed using the Hosmer–Lemeshow test and the area under the receiver operating characteristic curve (AUC).
Results: The overall 30-day complication rate was 21.3% (96/451). More than half of the procedures were performed in the ED (53.9%). Complication rates were highest in children younger than 6 years (38.2%, p=0.001) and in those with traumatic presentations (36.0% vs. 19.5%, p=0.04). General anesthesia was associated with higher complication rates compared with local anesthesia with or without sedation (34.5% vs. 13.4%, p<0.001). Multivariate analysis identified age <6 years (adjusted OR: 2.42, 95% CI: 1.38–4.24), traumatic etiology (adjusted OR: 1.86, 95% CI: 1.02–3.39), and general anesthesia (adjusted OR: 2.18, 95% CI: 1.34–3.54) as independent predictors. Procedure location was not independently associated with complications. Model discrimination was acceptable (AUC: 0.71).
Conclusion: In pediatric emergency tube thoracostomy, younger age, traumatic presentation, and the use of general anesthesia are independently associated with 30-day complications. Comparable complication rates across the ED and other emergency settings support the safety of emergency department–based tube thoracostomy when performed by trained providers. These findings may guide risk stratification and clinical decision-making in pediatric emergency medicine.

Keywords: Complications, emergency medicine, pneumothorax, risk factors, tube thoracostomy