Occult Pneumothorax in Trauma Patients: Development of an Objective Scoring System

Moya, Marc A. de; Seaver, Christopher; Spaniolas, Konstantinos; Inaba, Kenji; Nguyen, Michael; Veltman, Yevgeniy; Shatz, David V.; Alam, Hasan B.; Pizano, Louis R.

doi:10.1097/ta.0b013e31806864fc

Cited by 86 publications

(63 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Definimos el tratamiento como exitoso o fallido; si el neumotórax creció o hubo algún deterioro fisiológico del paciente que finalmente requirió el uso de sonda pleural, fue considerado como fallido. [1][2][3] Research Assistant, [4][5][6] Assistant Professor, 7 Professor 8 Associate Professor [1][2][3][4][5][6][7][8] Department of Surgery, Massachusetts General Hospital Boston, MA, USA Resultados: De un total de 165 pacientes con neumotórax, 17 (10.3%) midieron >35 mm y 148 (89.7%) midieron <35 mm. De los 17 >35 mm, 15 (88.7%) fueron tratados inmediatamente con sonda pleural.…”

Section: Materiales Y Métodosunclassified

“…4 An increasing body of literature supports observation in stable patients as an acceptable alternative to TT, with failure of observation rates approaching 6%. 5 Based on previous work, 6 we sought to explore if a PTX measuring ≤ 35 mm in patients who have no physiologic derangement may be safely observed without TT regardless of the need for positive pressure ventilation.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Pneumothoraces on Computed Tomography Scan: Observation using the 35 Millimeter Rule is Safe

Cropano¹,

Mesar²,

Turay³

et al. 2015

Panamerican Journal of Trauma, Critical Care &Amp; Emergency Surgery

View full text Add to dashboard Cite

Introduction:The management of a pneumothorax (PTX) either by observation or with a tube thoracostomy (TT) has long been dictated by practitioner discretion rather than objective criteria. Many physicians elect to routinely place a TT for traumatic PTX, particularly when patients undergo positive pressure ventilation (PPV). Placement of unnecessary TT exposes patients to avoidable morbidity and may prolong hospitalization. Based on prior work establishing a cutoff, we hypothesized that all PTXs ≤ 35 mm in patients who have no physiologic derangement may be safely observed without TT regardless of the need for PPV. Materials and methods:Retrospective review of all patients diagnosed with a PTX between 1/2009 and 2/2013. All PTXs visible on chest computed tomography (CT) were identified. Any patient with an associated significant hemothorax or those patients who were moribund were excluded. All PTXs were measured by measuring the perpendicular distance of the largest air pocket between the chest wall and the mediastinal or pulmonary structure. Management of the PTX was categorized as observation or TT. Observed PTXs were labeled as success or failure with failure defined as enlargement of the PTX or physiologic deterioration, requiring a TT.Results: Out of 165 PTXs, 17 (10.3%) measured >35 mm, whereas 148 (89.7%) measured ≤35 mm. Of the 17 > 35 mm, 15 (88.2%) received immediate TT. Of the two PTXs >35 mm which were observed, one received a delayed TT for a pleural effusion (6 days after PTX diagnosis) and one (5.9 %) was safely observed. Of the 148 PTXs which measured ≤ 35 mm, 10 (6.8%) received immediate TT. Of the 138 remaining PTXs, 129 (93.5%) were safely managed without TT. Six (4.3%) of the PTXs initially observed eventually required TT placement for enlargement of the PTX. Only one of those six had manifested ongoing desaturations prior to TT. The remaining three cases received TT for reasons unrelated to the PTX. Of the 27 PPV cases in the ≤35 mm cohort, none contributed to the six failures. A cutoff measurement of 35 mm demonstrated a negative predictive value (NPV) of 95.7% in its ability to predict successful observation of the PTX with an area under the receiver operating characteristic (ROC) curve of 0.90. Conclusion:All PTXs measuring ≤35 mm perpendicular to the chest wall without physiologic derangement may be safely observed independent of the need for mechanical ventilation. Source of support: Nil Conflict of interest: None RESUMENIntroducción: El manejo del neumotórax, ya sea con observación clínica o con sonda pleural, se ha basado en el juicio clínico y no en criterios objetivos.

show abstract

Section: Materiales Y Métodosunclassified

Section: Introductionmentioning

confidence: 99%

Pneumothoraces on Computed Tomography Scan: Observation using the 35 Millimeter Rule is Safe

Cropano¹,

Mesar²,

Turay³

et al. 2015

Panamerican Journal of Trauma, Critical Care &Amp; Emergency Surgery

View full text Add to dashboard Cite

show abstract

“…In a recent large retrospective study, de Moya [1] found a 6% incidence of pneumothorax in greater than 21,000 trauma patients. In the hospital setting, pneumothoraces are often diagnosed with X-ray and/or computed tomography (CT) scans of the thorax.…”

Section: Introductionmentioning

confidence: 98%

Can emergency medical services personnel identify pneumothorax on focused ultrasound examinations?

et al. 2009

View full text Add to dashboard Cite

Background Ultrasound is of proven accuracy in the diagnosis of pneumothorax. In certain locations, pre-hospital providers are adopting its use for the management of critically ill patients. Objectives To determine the sensitivity and specificity of emergency medical service (EMS) providers in identifying pneumothorax on ultrasound examinations. Methods This was an educational study evaluating 33 EMS providers. Each subject went through a brief didactic session covering the use of ultrasound in diagnosis of pneumothorax. They were then given an examination consisting of 20 individual ultrasound real-time video cases depicting either a pneumothorax or normal lung sliding. Sensitivities and specificities with 95% confidence intervals (95% CIs) were calculated for recognition of pneumothorax. Results The 33 study participants were able to identify pneumothorax with a sensitivity of 82% (95% CI 77-86%), specificity of 94% (95% CI 90-96%), positive predictive value of 93% (95% CI 89-95%), and negative predictive value of 84% (95% CI 80-87%). Conclusions Emergency medical service providers were able to identify pneumothorax at a relatively high rate. Real-time scanning by the study subjects might lead to even better results.

show abstract

“…Serial chest radiographs every 6hrs on the first day after injury to rule out pneumothorax is ideal, but two or three chest X-ray taken every 4 -6 hrs are sufficient [7]. A Computerized tomography (CT scan) is more sensitive than a chest radiograph in the evaluation of small pneumothorax and pneumomediastinum, although the clinical significance of these occult pneumothoraces is unclear, particularly in the stable non-intubated patient [8].…”

Section: Introductionmentioning

confidence: 99%

The Selective Conservative Management of Small Traumatic Pneumothorax Following Stab Injuries of the Chest in Emergency Department Patients

Ramadan¹,

Rizk²,

Nosseir³

et al. 2017

OJTS

View full text Add to dashboard Cite

Background: Chest trauma is a catastrophic event that affects large number of population and leads to morbidity, disability and mortality. The definition of an occult pneumothorax is uncontested. It is a pneumothorax that was not suspected on the basis of clinical examination or plain radiography, but was ultimately detected with CT and usually treated conservatively. We evaluated the success of selective conservative management of small pneumothorax following stab chest injuries, in Emergency Department patients. Methods: This prospective study was conducted on 30 adult patients admitted to the emergency department with small traumatic pneumothorax following stab injury. All enrolled patients (n = 30) were assessed for the following, demographic data, laboratory investigations, chest x-ray and CT scan. The outcomes measured were discharge safely after successful conservative management, Initial conservative then invasive measurement. Results: There was a statistically significant difference between conservative and non-conservative types of management in the incidence of complications after 1 week follow up (p = 0.001). Conclusion: The majority of asymptomatic small pneumothorax patients following a stab injury can be managed conservatively. Haphazard chest tube insertion and aging may lead to complications in such patients.

show abstract

Occult Pneumothorax in Trauma Patients: Development of an Objective Scoring System

Cited by 86 publications

References 8 publications

Pneumothoraces on Computed Tomography Scan: Observation using the 35 Millimeter Rule is Safe

Pneumothoraces on Computed Tomography Scan: Observation using the 35 Millimeter Rule is Safe

Can emergency medical services personnel identify pneumothorax on focused ultrasound examinations?

The Selective Conservative Management of Small Traumatic Pneumothorax Following Stab Injuries of the Chest in Emergency Department Patients

Contact Info

Product

Resources

About