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Occult pneumothorax in blunt trauma: is there a need for tube thoracostomy?

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

An Erratum to this article was published on 07 April 2016

Abstract

Introduction/background

Occult pneumothorax (OPTX) is defined as air within the pleural cavity that is undetectable on normal chest X-rays, but identifiable on computed tomography. Currently, consensus is divided between tube thoracostomy and conservative management for OPTX.

Methods

The aim of this retrospective study is to determine whether OPTX can be managed conservatively and whether any adverse events occur under conservative management. Data on all trauma patients from 1 Jan 2010 to 31 December 2012 were obtained from our hospital’s trauma registry. All patients with occult pneumothorax who had chest X-ray (CXR) and any CT scan visualizing the thorax were included. The exclusion criteria included those with penetrating wounds; CXR showing pneumothorax, hemothorax, or hemopneumothorax; those with prophylactic chest tube insertion before CT; and those with no CT diagnosis of OPTX. The complications of these patients were analyzed to determine if tube thoracostomy is necessary for OPTX and whether not inserting it would alter the outcome significantly.

Results

A total of 1564 cases were reviewed and 83 patients were included. Of these 83 patients, 35 (42.2 %) had tube thoracostomy after OPTX detection and 48 (57.8 %) were observed initially. Patients who had tube thoracostomy had similar ISS compared to those without (median ISS 17 vs. 18.5, p = 0.436). Out of the 48 patients who did not have tube thoracostomy on detection of an OPTX, 4 (8.3 %) had complications. In the group of 35 patients who had tube thoracostomy on detection of an OPTX, 7 (20 %) had complications. Of the 83 patients, a total of 12 patients had IPPV, of which 7 (58.3 %) had tube thoracostomy and 5 (41.7 %) did not. Patients who had tube thoracostomy under our care have a statistically significant likelihood of experiencing any complication compared to those without tube thoracostomy (odds ratio 9.92. The median length of stay was also longer (13 days) in those who had tube thoracostomy compared to those without (5 days) (p value = 0.008).

Conclusions

Our study suggests that patients with OPTX can be managed conservatively with close monitoring, but only in areas with ready access to emergency facilities should any adverse events occur.

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References

  1. Mettler FA Jr, Wiest PW, Locken JA, et al. CT scanning: patterns of use and dose. J Radiol Prot. 2000;20(4):353–9.

    Article  PubMed  Google Scholar 

  2. Plurad D, Green D, Demetriades D, et al. The increasing use of chest computed tomography for trauma: is it being overutilized? J Trauma. 2007;62(3):631–5.

    Article  PubMed  Google Scholar 

  3. Ball CG, Kirkpatrick AW, Laupland KB, et al. Incidence, risk factors, and outcomes for occult pneumothoraces in victims of major trauma. J Trauma. 2005;59:917–25.

    Article  PubMed  Google Scholar 

  4. Lee Ryan KL, Graham Colin A, Yeung Janice HH, et al. Occult pneumothoraces in Chinese patients with significant blunt chest trauma: radiological classification and proposed clinical significance. Injury Int J Care Injured. 2012;43:2105–8.

    Article  Google Scholar 

  5. Ball CG, Hameed SM, Evans D, et al. Occult pneumothorax in the mechanically ventilated trauma patient. Can J Surg. 2003;46:373–9.

    PubMed  PubMed Central  Google Scholar 

  6. Andrew W. Kirkpatrick, MD, Sandro Rizoli, MD, Jean-Francois Ouellet, MD, et al. Occult pneumothoraces in critical care: a prospective multicenter randomized controlled trial of pleural drainage for mechanically ventilated trauma patients with occult pneumothoraces. J Trauma Acute Care Surg. 2012;74(3).

  7. Etoch SW, Bar-Natan MF, Miller FB, et al. Tube thoracostomy. Factors related to complications. Arch Surg. 1995;130:521–5.

    Article  CAS  PubMed  Google Scholar 

  8. Moore Forrest O, Goslar Pamela W, Coimbra Raul, et al. Blunt traumatic occult pneumothorax: is observation safe?—results of a prospective, AAST Multicenter Study. J Trauma. 2011;70:1019–25.

    Article  PubMed  Google Scholar 

  9. Guerrero-Lopez F, Vasquez-Mata G, Alcazar-Romero P, Ferna´ndez-Monde´jar E, et al. Evaluation of the utility of computed tomography in the initial assessment of the critical care patient with chest trauma. Crit Care Med. 2000;28:1370–5.

    Article  CAS  PubMed  Google Scholar 

  10. de Moya MA, Seaver C, Spaniolas K, et al. Occult pneumothorax in trauma patients: development of an objective scoring system. J Trauma. 2007;63(1):13–7.

    Article  PubMed  Google Scholar 

  11. Brasel KJ, Stafford RE, Weigelt JA, et al. Treatment of occult pneumothoraces from blunt trauma. J Trauma. 1999;46:987–91.

    Article  CAS  PubMed  Google Scholar 

  12. Collins JC, Levine G, Waxman K. Occult traumatic pneumothorax: immediate tube thoracostomy versus expectant management. Am Surg. 1992;58:743–6.

    CAS  PubMed  Google Scholar 

  13. Wilson H, Ellsmere J, Tallon J, Kirkpatrick A. Occult pneumothorax in the blunt trauma patient: tube thoracostomy or observation? Injury. 2009;40(9):928–31. doi:10.1016/j.injury.2009.04.005 [Epub 2009 Jun 17].

    Article  PubMed  Google Scholar 

  14. Enderson BL, Abdalla R, Frame SB, et al. Tube thoracostomy for occult pneumothorax: a prospective randomized study of its use. J Trauma. 1993;35:726–9.

    Article  CAS  PubMed  Google Scholar 

  15. Hill SL, Edmisten T, Holtzman G, Wright A. The occult pneumothorax: an increasing diagnostic entity in trauma. Am Surg. 1999;65:254–8.

    CAS  PubMed  Google Scholar 

  16. Garramone RR, Jacobs LM, Sahdev P. An objective method to measure and manage occult pneumothorax. Surg Gynecol Obstet. 1991;173:257–61.

    PubMed  Google Scholar 

  17. Eileen M. Bulger, Inpatient management of traumatic rib fractures. In: Basow DS, editor. UpToDate. Waltham: UpToDate; 2013.

    Google Scholar 

  18. Gosain Ankush, Dipietro LA. Aging and wound healing. World J Surg. 2004;28(3):p321–6.

    Article  Google Scholar 

  19. Yadav Kabir, Jalili Mohammad, Zehtabchi Shahriar. Management of traumatic occult pneumothorax. Resuscitation. 2010;81(9):1063–8.

    Article  PubMed  Google Scholar 

  20. Ball CG, Lord J, Laupland KB, et al. Chest tube complications: how well are we training our residents. Can J Surg. 2007;50:450–8.

    PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Trauma and Acute Care Surgery, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore

    L. T. Teo, M. H. Goh & K. T. S. Go

  2. Department of Orthopaedics, National University Hospital, Singapore, Singapore

    M. Zhang

  3. Department of Urology, Tan Tock Seng Hospital, Singapore, Singapore

    J. Leow

Authors
  1. M. Zhang
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  2. L. T. Teo
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  3. M. H. Goh
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  4. J. Leow
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  5. K. T. S. Go
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Corresponding author

Correspondence to M. Zhang.

Ethics declarations

This is to state that the Institutional Review Board approval was waived for the authors—Margaret Zhang, Li Tserng Teo, Mui Heng Goh, Jeffrey Leow and Karen T.S. Go.

Conflict of interest

This is to state that Margaret Zhang, Li Tserng Teo, Mui Heng Goh, Jeffrey Leow and Karen T.S. Go declare that there are no conflicts of interest with regard to the study.

Additional information

An erratum to this article is available at http://dx.doi.org/10.1007/s00068-016-0666-5.

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Zhang, M., Teo, L.T., Goh, M.H. et al. Occult pneumothorax in blunt trauma: is there a need for tube thoracostomy?. Eur J Trauma Emerg Surg 42, 785–790 (2016). https://doi.org/10.1007/s00068-016-0645-x

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  • DOI: https://doi.org/10.1007/s00068-016-0645-x

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