Occult pneumothorax in patients presenting with blunt chest trauma : an observational analysis

Abstract EN

Background: We aimed to assess the management and outcome of occult pneumothorax and to determine the factors associated with failure of observational management in patients with blunt chest trauma (BCT).

Methods: Patients with BCT were retrospectively identified from the trauma database over 4 years.

Data were analyzed and compared on the basis of initial management (conservative vs.

tube thoracostomy).

Results: Across the study period, 1928 patients were admitted with BCT, of which 150 (7.8%) patients were found to have occult pneumothorax.

The mean patient age was 32.8 ^ 13.7 years, and the majority were male (86.7%).

Positive-pressure ventilation (PPV) was required in 32 patients, and bilateral occult pneumothorax was seen in 25 patients.

In 85.3% (n ¼ 128) of cases, occult pneumothorax was managed conservatively, whereas 14.7% (n ¼ 22) underwent tube thoracostomy.

Five patients had failed observational treatment requiring delayed tube thoracostomy.

Pneumonia was reported in 12.8% of cases.

Compared with those who were treated conservatively, patients who underwent tube thoracostomy had thicker pneumothoraxes and a higher rate of lung contusion, rib fracture, pneumonia, prolonged ventilatory days, and prolonged hospital length of stay.

Overall mortality was 4.0%.

The deceased had more polytrauma and were treated conservatively without a chest tube.

Patients who failed conservative management had a higher frequency of lung contusion, greater pneumothorax thickness, higher Injury Severity Scores (ISS), and required more PPV.