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Observation period for asymptomatic penetrating chest trauma: 1 or 3 h?

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

Abstract

Background

Current recommendations for evaluation and safe discharge of penetrating chest trauma patients regarding pneumothorax (PTX) include a Chest X Ray (CXR) at the Emergency Department (ED) upon arrival and second CXR after 3 h if the first one is negative.

Purpose

To compare CXRs taken at the first and third hours of ED arrival and evaluate a 1 h period of observation instead of 3 h for safe discharge of patients with penetrating chest trauma.

Methods

In this cross-sectional study, all asymptomatic patients with penetrating chest trauma referred to a level 1 trauma center with negative initial Postero-Anterior (PA) CXRs (hour 0) were enrolled. Those with intoxication, tube thoracostomy, chest computed tomography, evidence of abdominal penetration, an overall elapsed timed of more than 1 h for admission to the ED, and refusal to take part in the study were excluded. Patients underwent subsequent PA CXRs at hours 1 and 3. A phone call follow up after 24 h was organized for each patient.

Results

A total of 68 patients were enrolled. There was 100 % concordance among CXRs performed at hours 1 and 3 in the study population. None of the patients showed clinical deterioration or PTX in CXR at hour 1 if remained asymptomatic during the first hour of observation.

Conclusion

Asymptomatic patients with penetrating chest trauma, negative initial PA CXR, no signs of intoxication, and no deterioration during the first hour of observation may be considered for discharge. Further evidence is required to make recommendations based on these findings.

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Authors and Affiliations

  1. Department of Emergency Medicine, Bahonar Academic Hospital, Kerman University of Medical Sciences, Kerman, Iran

    L. Seidzadeh Gooklan, A. Yari, M. Mayel, M. Movahedi & A. Mirafzal

  2. Department of Radiology, Kerman University of Medical Sciences, Kerman, Iran

    S. Nazemi

Authors
  1. L. Seidzadeh Gooklan
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  2. A. Yari
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  3. M. Mayel
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  4. S. Nazemi
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  5. M. Movahedi
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  6. A. Mirafzal
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Corresponding author

Correspondence to A. Mirafzal.

Ethics declarations

This study was approved by the Institutional Review Board of Kerman University of Medical Sciences and performed in accordance with declaration of Helsinky. Since this study involved a single CXR in addition to the standard of care (the hour 1 CXR), a statement was added to the consent form of the patients, including the translation of the following announcement into Persian: “This study involves radiation exposure from a chest X-ray. As part of everyday living, everyone is exposed to a small amount of background radiation that comes from the environment you live in. The radiation dose you will receive in this study is about the amount that you receive over 3 days from background radiation. The risk from this dose is small. This radiation exposure is not necessary for your medical care but is necessary to obtain the research information desired.”

Conflict of interest

Latifeh Seidzadeh Gooklan, Alireza Yari, Masoud Mayel, Mitra Movahedi, Sarir Nazemi, and Amirhossein Mirafzal report no conflicts of interests.

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Seidzadeh Gooklan, L., Yari, A., Mayel, M. et al. Observation period for asymptomatic penetrating chest trauma: 1 or 3 h?. Eur J Trauma Emerg Surg 44, 829–833 (2018). https://doi.org/10.1007/s00068-015-0623-8

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  • DOI: https://doi.org/10.1007/s00068-015-0623-8

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