Factors Associated with Chest Tube Placement in Blunt Trauma Patients with an Occult Pneumothorax

Abstract EN

Background.

An occult pneumothorax is identified by computed tomography but not visualized by a plain film chest X-ray.

The optimal management remains unclear.

Methods.

A retrospective review of an urban level I trauma center’s trauma registry was conducted to identify patients with occult pneumothorax over a 2-year period.

Factors predictive of chest tube placement were identified using univariate and multivariate logistic regression analysis.

Results.

A total of 131 patients were identified, of whom 100 were managed expectantly with an initial period of observation.

Ultimately, 42 (32.0%) patients received chest tubes and 89 did not.

The patients who received chest tubes had larger pneumothoraces at initial assessment, a higher incidence of rib fractures, and an increased average number of rib fractures, of which significantly more were displaced.

Conclusions.

Displaced rib fractures and moderate-sized pneumothoraces are significant factors associated with chest tube placement in a victim of blunt trauma with occult pneumothorax.

The optimal timing for the first follow-up chest X-ray remains unclear.