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Management of computed tomography-detected pneumothorax in patients with blunt trauma: experience from a community-based hospital.

Research paper by Ashraf F AF Hefny, Fathima T FT Kunhivalappil, Nikolay N Matev, Norman A NA Avila, Masoud O MO Bashir, Fikri M FM Abu-Zidan

Indexed on: 26 Jul '17Published on: 26 Jul '17Published in: Singapore medical journal



Abstract

With near-routine use of computed tomography (CT) for imaging trauma patients, the diagnosis of pneumothorax, especially occult pneumothorax, has increased. However, the need for chest tube insertion remains controversial. We aimed to study the management of pneumothorax detected on CT among patients with blunt trauma, including the decision for tube thoracostomy, in a community-based hospital.Chest CT scans of patients with blunt trauma treated at Al Rahba Hospital, Abu Dhabi, from October 2010 to October 2014 were retrospectively studied. Variables studied included demography, mechanism of injury, endotracheal intubation, pneumothorax volume, chest tube insertion, Injury Severity Score, hospital length of stay and mortality.CT was performed in 703 patients with blunt trauma. Overall, pneumothorax was detected on CT for 74 (10.5%) patients - for 65 patients, pneumothorax was detected before chest tube insertion. Among these 65 patients, 25 (38.5%) needed chest tube insertion while 40 (61.5%) did not. Backward stepwise likelihood regression showed that independent factors that significantly predicted chest tube insertion were endotracheal intubation (p = 0.01), non-UAE (United Arab Emirates) nationality (p = 0.01) and pneumothorax volume (p = 0.03). The receiver operating characteristic curve showed that the best pneumothorax volume that predicted chest tube insertion was 30 mL.Chest tube was inserted in less than half of patients with blunt trauma for whom pneumothorax was detected on CT. Pneumothorax volume should be included in the decision-making regarding chest tube insertion. Observation of pneumothorax of volume less than 30 mL appears safe.