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The selective conservative management of small traumatic pneumothoraces following stab injuries is safe: experience from a high-volume trauma service in South Africa

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Abstract

Objective

The selective conservative management of small pneumothoraces (PTXs) following stab injuries is controversial. We reviewed a cohort of patients managed conservatively in a high volume trauma service in South Africa.

Materials and methods

A retrospective review over a 2-year period identified 125 asymptomatic patients with small PTXs measuring <2 cm on chest radiograph who were managed conservatively.

Results

Of the 125 patients included in the study, 92 % were male (115/125), and the median age for all patients was 21 years (19–24). Ninety-seven per cent (121/125) of the weapons involved were knives, and 3 % (4/125) were screwdrivers. Sixty-one per cent of all injuries were on the left side. Eighty-two per cent (102/125) sustained a single stab, and 18 % (23/125) had multiple stabs. Thirty-nine per cent (49/125) had a PTX <0.5 cm (Group A), 26 % (32/125) were ≥0.5 to <1 cm (Group B), 19 % (24/125) were ≥1 to <1.5 cm (Group C) and 15 % (20/125) were ≥1.5 to <2 cm (Group D). Three per cent of all patients (4/125) eventually required ICDs (one in Group C, three in Group D). All four patients had ICDs in situ for 24 h. The remaining 97 % (121/125) were all managed successfully by active clinical observation alone. There were no subsequent readmissions, morbidity or mortality as a direct result of our conservative approach.

Conclusions

The selective conservative management of asymptomatic small PTXs from stab injuries is safe if undertaken in the appropriate setting.

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Conflict of interest

Victor Kong, George Oosthuizen, and Damian Clarke declare that they have no conflict of interest.

Compliance with Ethics Guidelines

This article does not contain any studies with human or animal subjects performed by any of the authors. Ethical approval for this study and to maintain our registry was granted by the Biomedical Research Ethics Committee (BREC) of the University of KwaZulu Natal (reference number: BE 207/09).

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Authors and Affiliations

  1. Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu Natal, Pietermaritzburg, 3216, South Africa

    V. Y. Kong, G. V. Oosthuizen & D. L. Clarke

Authors
  1. V. Y. Kong
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  2. G. V. Oosthuizen
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  3. D. L. Clarke
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Correspondence to V. Y. Kong.

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Kong, V.Y., Oosthuizen, G.V. & Clarke, D.L. The selective conservative management of small traumatic pneumothoraces following stab injuries is safe: experience from a high-volume trauma service in South Africa. Eur J Trauma Emerg Surg 41, 75–79 (2015). https://doi.org/10.1007/s00068-014-0426-3

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  • DOI: https://doi.org/10.1007/s00068-014-0426-3

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