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Traumatic tension pneumothorax: experience from 115 consecutive patients in a trauma service in South Africa

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Introduction

Traumatic tension pneumothorax (TPTX) is a life threatening condition, but literature describing this condition specifically in developing countries is scarce.

Materials and methods

We conducted a retrospective review of 115 patients with a TPTX, managed over a 4-year period in a high volume trauma service in South Africa.

Results

A total of 118 TPTXs were identified in 115 patients. Eighty-nine percent (102/115) were males, and the mean age was 26 years (SD ± 6 years). Seventy-four percent (87/118) of all TPTXs occurred on the left side. The mechanisms of injury were penetrating in 71 % (82/115) [82 stab injuries], and blunt in 29 % (33/115) [31 road traffic accidents and 2 assaults]. Ninety-seven percent (111/115) of patients presented directly to our unit, while 3 % (4/115) were referrals from other hospitals. Fifteen percent (17/115) of needle decompressions were performed in the pre-hospital setting while the remaining 85 % (98/115) were performed on arrival (73 were recognised clinically and 25 were not). Of the 25 TPTXs that were not recognised clinically on initial assessment, 12 were discovered on CXR, 8 on CT scans and 5 in the operating room (OR). The overall mortality was 9 % (10/115) [7 in CXR, 2 in CT, 1 in OR]. None of the patients who had the TPTXs identified on initial clinical assessment died (0/73), compared with those who were missed on initial clinical assessment, in which the mortality was significantly higher at 40 % (10/25), (p < 0.001).

Conclusions

Penetrating injuries accounted for the majority of TPTXs seen in our setting. Clinical recognition of the entity may be challenging and delayed recognition is associated with significant mortality.

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Conflict of interest

V. Kong, B. Sartorius, and D. Clarke declare that they have no conflict of interest.

Compliance with ethics guidelines

V. Kong, B. Sartorius, and D. Clarke declare that: all procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5). Informed consent was obtained from all patients for being included in the study.

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Authors and Affiliations

  1. Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu Natal, Pietermaritzburg, South Africa

    V. Kong & D. Clarke

  2. Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu Natal, Durban, South Africa

    B. Sartorius

Authors
  1. V. Kong
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  2. B. Sartorius
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  3. D. Clarke
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Correspondence to V. Kong.

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Kong, V., Sartorius, B. & Clarke, D. Traumatic tension pneumothorax: experience from 115 consecutive patients in a trauma service in South Africa. Eur J Trauma Emerg Surg 42, 55–59 (2016). https://doi.org/10.1007/s00068-015-0502-3

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  • DOI: https://doi.org/10.1007/s00068-015-0502-3

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