Many patients with small hemothoraces or pneumothoraces were observed without tube thoracostomy. Treatment recommendations for hemothorax and pneumothorax were codified when most of these injuries were identified with plain films. However, increased use of computed tomography (CT) allows detection of smaller injuries, raising the question of which injuries require chest tube drainage. These authors performed a secondary analysis of two observational NEXUS Chest cohorts to determine current treatment practices for pneumothoraces and hemothoraces detected by CT but not by plain films. Enrolled patients were older than 14 years; presented to one of 10 urban, U.S. level 1 trauma centers within 6 hours of blunt trauma; and underwent chest CT or x-ray. Among 21,382 enrolled patients, 1064 (5%) had pneumothorax and 384 (2%) had hemothorax. Ninety percent of patients with pneumothorax or hemothorax had other chest injuries, most commonly rib fractures or pulmonary contusions. Among 8661 patients who underwent both x-ray and CT, 67% of pneumothoraces and 80% of hemothoraces were seen on CT only. Patients with injuries detected only on CT, compared with CT and x-ray, had lower rates of tube thoracostomy (30% vs. 65% for those with pneumothoraces; 49% vs. 68% for those with hemothoraces). |
|
|
Leave a Reply Cancel reply
You must be logged in to post a comment.
COMMENT
These observational data can’t tell us which patients can forego tube thoracostomy in the face of small hemothoraces or pneumothoraces. However, they do tell us that observation without tube thoracostomy is within the standard of care for some patients. The Eastern Association for the Surgery of Trauma recommends observation without chest tube placement for most hemodynamically stable patients with small isolated injuries seen only on CT.