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 < 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 < 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 0–1 to 3–4; p = 0.157, test for trend p = 0.738), by tube size (≤28 F 12.0% versus ≥32 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.

Background. Intravenous (IV) thrombolysis is the standard of care for acute ischaemic stroke (AIS), yet there is still no objective bedside tool for monitoring the brain continuously during the infusion. Near-infrared spectroscopy (NIRS) provides non-invasive, continuous measurement of regional cerebral oxygen saturation (rSO₂). We evaluated whether bilateral frontal NIRS, and in particular the absolute interhemispheric difference in rSO₂ (ΔNIRS), tracks the clinical trajectory of patients receiving IV alteplase in the emergency department (ED). Methods. A prospective observational cohort study was conducted in the ED of a tertiary university hospital. Consecutive adults receiving IV alteplase for AIS were screened, and those enrolled underwent continuous bilateral frontal NIRS monitoring. Bilateral rSO₂, ΔNIRS, vital signs, Glasgow Coma Scale (GCS) and National Institutes of Health Stroke Scale (NIHSS) were recorded at baseline and at 0, 15, 30, 45, 60 and 120 min after the start of the infusion. Patients were classified by clinical trajectory during monitoring as improvement, no change, or deterioration. Results. Forty-one patients were analyzed (26 female, 63.4%; mean age 73.6 ± 14.8 years); 15 (36.6%) improved, 21 (51.2%) showed no change and 5 (12.2%) deteriorated. In the whole cohort, absolute rSO₂ rose only slightly in the affected hemisphere and did not change in the unaffected hemisphere. However, affected-hemisphere rSO₂ rose significantly in the improvement group (median 59 to 67; p = 0.001) and fell significantly in the deterioration group (p = 0.015). ΔNIRS narrowed from a median of 4 (IQR 3–9) at baseline to 1 (IQR 0–5) at 120 min in the improvement group (p = 0.034) and did not change significantly in the other groups. The two patients with acute complications desaturated bilaterally. NIHSS correlated strongly and inversely with GCS at every time point (ρ = −0.74 to −0.84; all p < 0.001). Conclusions. During IV thrombolysis in the ED, continuous bilateral frontal NIRS tracked the clinical trajectory. Because recanalisation and reperfusion were not assessed independently, what NIRS paralleled was the clinical course, not reperfusion itself. These hypothesis-generating findings warrant larger studies that validate ΔNIRS against perfusion or vascular imaging.