Control chest x-ray in patients with asymptomatic posttraumatic pneumothorax

Julieta Correa-Restrepo, Mónica Restrepo-Moreno, Luis Guillermo Peláez, Rafael Díaz-Cadavid, Yuliana López-Vasco, María Alejandra Rojas, David Alejandro Mejía-Toro, Carlos Hernando Morales-Uribe

Article ID: 1734
Vol 4, Issue 1, 2021

VIEWS - 684 (Abstract) 413 (PDF)

Abstract


Introduction: Chest trauma has a high incidence and pneumothorax is the most frequent finding. The literature is scarce on what to do with asymptomatic patients with pneumothorax due to penetrating chest trauma. The aim of this study was to evaluate what are the findings of the control radiography of patients with penetrating chest trauma who are not initially taken to surgery, and their usefulness in determining the need for further treatment. Methods: A retrospective cohort study was performed, including patients older than 15 years who were admitted for penetrating chest trauma between January 2015 and December 2017 and who did not require initial surgical management. We analyzed the results of chest radiography, the time of its acquisition, and the behavior decided according to the findings in patients initially left under observation. Results: A total of 1,554 patients were included, whose average age was 30 years, 92.5% were male and 97% had a sharp weapon wound. Of these, 186 (51.5%) had no alterations in their initial X-ray, 142 had pneumothorax less than 30% and 33 had pneumothorax greater than 30 %, hemopneumothorax or hemothorax. Closed thoracostomy was required as the final procedure in 78 cases, sternotomy or thoracotomy in 2 cases and discharged in 281. Conclusion: In asymptomatic patients with small or moderate pneumothorax and no other significant lesions, longer observation times, radiographs and closed thoracostomy may be unnecessary.


Keywords


Thoracic Trauma; Pneumothorax; Diagnosis; Imaging; Thoracic Radiography; Conservative Treatment

Full Text:

PDF


References


1. Mowery NT, Gunter OL, Collier BR, et al. Practice management guidelines for management of hemothorax and occult pneumothorax. Journal of Trauma 2011; 70: 510–518.

2. Ball CG, Dente CJ, Kirkpatrick AW, et al. Occult pneumothoraces in patients with penetrating trauma: does mechanism matter? Canadian Journal of Surgery 2010; 53: 251–255.

3. Ball CG, Ranson K, Dente CJ, et al. Clinical predictors of occult pneumothoraces in severely injured blunt polytrauma patients: a prospective observational study. Injury 2009; 40: 44–47.

4. Zehtabchi S, Morley EJ, Sajed D, et al. Delayed pneumothorax after stab wound to thorax and upper abdomen: truth or myth? Injury 2009; 40: 40–43.

5. Ball CG, Kirkpatrick AW, Laupland KB, et al. Factors related to the failure of radiographic recognition of occult posttraumatic pneumothoraces. American Journal of Surgery 2005; 189: 541–546.

6. Berg RJ, Inaba K, Recinos G, et al. Prospective evaluation of early follow-up chest radiography after penetrating thoracic injury. World Journal of Surgery 2013; 37: 1286–1290.

7. Shatz DV, de la Pedraja J, Erbella J, et al. Efficacy of follow-up evaluation in penetrating thoracic injuries: 3- vs. 6-hour radiographs of the chest. The Journal of Emergency Medicine 2001; 20: 281–284.

8. Kerr TM, Sood R, Buckman RF, et al. Prospective trial of the six-hour rule in stab wounds of the chest. Surgery, Gynecology & Obstetrics 1989; 169: 223–225.

9. Rhea JT, DeLuca SA, Greene RE. Determining the size of pneumothorax in the upright patient. Radiology 1982; 144: 733–736.

10. Collins CD, Lopez A, Mathie A, et al. Quantification of pneumothorax size on chest radiographs using interpleural distances: regression analysis based on volume measurements from helical CT. AJR. American Journal of Roentgenology 1995; 165: 1127–1130.

11. Baumann MH, Strange C, Heffner JE, et al. Management of spontaneous pneumothorax: An American College of Chest Physicians Delphi consensus statement. Chest 2001; 119: 590–602.

12. MacDuff A, Arnold A, Harvey J, et al. Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010. Thorax 2010; 65(Suppl.2): ii18–ii31.

13. Ball CG, Kirkpatrick AW, Feliciano DV. The occult pneumothorax: What have we learned? Canadian Journal of Surgery 2009; 52: E173–179.

14. Charbit J, Millet I, Maury C, et al. Prevalence of large and occult pneumothoraces in patients with severe blunt trauma upon hospital admission: experience of 526 cases in a French level 1 trauma center. The American Journal of Emergency Medicine 2015; 33: 796–801.

15. Mollberg NM, Wise SR, De Hoyos AL, et al. Chest computed tomography for penetrating thoracic trauma after normal screening chest roentgenogram. The Annals of Thoracic Surgery 2012; 93: 1830–1835.

16. Kea B, Gamarallage R, Vairamuthu H, et al. What is the clinical significance of chest CT when the chest X-ray result is normal in patients with blunt trauma? The American Journal of Emergency Medicine 2013; 31: 1268–1273.

17. Blaivas M, Lyon M, Duggal S. A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax. Academic Emergency Medicine 2005; 12: 844–849.

18. Johnson G. Traumatic pneumothorax: Is a chest drain always necessary? Emergency Medicine Journal 1996; 13: 173–174.

19. Llaquet Bayo H, Montmany Vioque S, Rebasa P, et al. Results of conservative treatment in patients with occult pneumothorax. Cirugía Española 2016; 94: 232–236.

20. Tapias L, Tapias-Vargas LF, Tapias-Vargas L. Complications of chest tubes. Revista Colombiana de Cirugía 2009; 24: 46–55.

21. Idris BM, Hefny AF. Large pneumothorax in blunt chest trauma: Is a chest drain always necessary in stable patients? A case report. International Journal of Surgery Case Reports 2016; 24: 88–90.

22. Kirkpatrick AW, Stephens MV, Fabian T. Canadian Association of General Surgeons and American College of Surgeons evidence based reviews in surgery: Treatment of occult pneumothorax from blunt trauma. Canadian Journal of Surgery 2006; 49: 358–361.

23. McLatchie GR, Campbell C, Hutchison JS. Pneumothorax of late onset after chest stabbings. Injury 1980; 11: 331–335.

24. Molnar TF. Thoracic trauma: Which chest tube when and where? Thoracic Surgery Clinics 2017; 27: 13–23.

25. Kircher LT, Swartzel RL. Spontaneous pneumothorax and its treatment. Journal of the American Medical Association 1954; 155: 24–29.

26. Symington L, McGugan E. Towards evidence based emergency medicine: Best BETs from the Manchester Royal Infirmary. Bet 1: Is a chest drain necessary in stable patients with traumatic pneumothorax? Emergency Medicine Journal 2008; 25: 439–440.

27. Henry M, Arnold T, Harvey J, et al. BTS guidelines for the management of spontaneous pneumothorax. Thorax 2003; 58(Suppl.2): ii39–ii52.

28. Seamon MJ, Medina CR, Pieri PG, et al. Follow-up after asymptomatic penetrating thoracic injury: 3 hours is enough. Journal of Trauma and Acute Care Surgery 2008; 65: 549–553.

29. Weigelt JA, Aurbakken CM, Meier DE, et al. Management of asymptomatic patients following stab wounds to the chest. The Journal of Trauma 1982; 22: 291–294.

30. Mabry R, McManus JG. Prehospital advances in the management of severe penetrating trauma. Critical Care Medicine 2008; 36(Suppl.): S258–S266.

31. Neff MA, Monk JS, Peters K, et al. Detection of occult pneumothoraces on abdominal computed tomographic scans in trauma patients. Journal of Trauma and Acute Care Surgery 2000; 49: 281–285.




DOI: https://doi.org/10.24294/irr.v4i1.1734

Refbacks

  • There are currently no refbacks.


Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Creative Commons License

This site is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.