Traumatic pneumothorax: is a chest drain always necessary?

Johnson, Graham

doi:10.1136/emj.13.3.173

Cited by 64 publications

(43 citation statements)

References 7 publications

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“…Most surgeons and emergency physicians will place a chest tube in occult and nonoccult traumatic pneumothoraces. However, studies suggest that carefully selected patients may be treated conservatively ultimately requiring chest tube placement only in about 10% of cases [86]. If positive pressure ventilation is anticipated, placement of a chest tube is mandatory.…”

Section: Traumatic Noniatrogenic Pneumothoraxmentioning

confidence: 99%

Pneumothorax

Noppen

Keukeleire²

2008

Respiration

275

232

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Section: Traumatic Noniatrogenic Pneumothoraxmentioning

confidence: 99%

Pneumothorax

Noppen

Keukeleire²

2008

Respiration

275

232

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“…Recently, the necessity of chest drain insertion for a proportion of traumatic pneumothoraces has been challenged. 2 The justification for this proposed change is the high complication rate some authors associate with tube thoracostomy. [3][4][5][6] These complications can be categorised as insertional, positional, or infective.…”

mentioning

confidence: 99%

Complications of tube thoracostomy in trauma

Bailey

2000

Emergency Medicine Journal

159

108

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Objective-To assess the complication rate of tube thoracostomy in trauma. To consider whether this rate is high enough to support a selective reduction in the indications for tube thoracostomy in trauma. Methods-A retrospective case series of all trauma patients who underwent tube thoracostomy during a 12 month period at a large UK teaching hospital with an accident and emergency (A&E) department seeing in excess of 125 000 new patients/ year. These patients were identified using the hospital audit department computerised retrieval system supplemented by a hand search of both the data collected for the Major Trauma Outcome Study and the A&E admission unit log book. The notes were assessed with regard to the incidence of complications, which were divided into insertional, infective, and positional. Results-Fifty seven chest drains were placed in 47 patients over the 12 month period. Seven patients who died within 48 hours of drain insertion were excluded. The commonest indications for tube thoracostomy were pneumothorax (54%) and haemothorax (20%); 90% of tubes were placed as a result of blunt trauma. The overall complication rate of the procedure was 30%. There were no insertional complications and only one (2%) major complication, which was empyema thoracis. Conclusion-This study reveals no persuasive evidence to support a selective reduction in the indications for tube thoracostomy in trauma. A larger study to confirm or refute these findings must be performed before any change in established safe practice.

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“…The incident rate of CTD varied from 31 [33] to 67% [29] of traumatic pneumothorax patents, and up to 82% for patients with concurrent pneumothorax and hemothorax [34]. However, some studies suggest that carefully selected patients may be treated conservatively, ultimately requiring CTD only in about 10% of cases [19,35]. This large variance in practice reflects the difficulty clinicians have in determining the appropriate treatment for pneumothorax.…”

Section: Multidetector Computed Tomography Management Of Pneumothoraxmentioning

confidence: 92%

“…Some studies suggest that it is not safe to manage patients with small occult pneumothoraces without CTD [43], whereas some suggest that small overt pneumothoraces can be managed without CTD [44]. Some found that not only small, but also moderate-sized traumatic pneumothoraces could be managed without CTD, in the absence of other significant injuries or respiratory compromise [35,45]. Additionally, the two randomized clinical trials in the literature have conflicting results; OPTX patients with positive pressure ventilation (PPV) would need CTD [41], versus all traumatic OPTXs could be managed safely without CTD [46], despite positive pressure ventilation.…”

Section: Multidetector Computed Tomography Management Of Pneumothoraxmentioning

confidence: 97%