Conservative management of traumatic pneumothoraces: A retrospective cohort study. (25th August 2021)

• Record Type: Journal Article
• Authors: Gerhardy, Benjamin C; Liebenberg, Paul; Simpson, Graham
• Is Part Of: Emergency medicine Australasia. Volume 34:Number 2(2022)
• Page Start: 194
• Page End: 198
• Publication Date: 2021-08-25
• Subjects: conservative -- pneumothorax -- trauma; Emergency medicine -- Periodicals; Emergency medicine -- Australasia -- Periodicals; 616.025
• DOI: 10.1111/1742-6723.13846
• Languages: English
• ISSNs: 1742-6731

Abstract

Abstract: Objective: Traumatic pneumothoraces (T‐PTXs) are traditionally managed with an intercostal catheter (ICC), despite little evidence for this. Success with conservative management of primary spontaneous PTX has been demonstrated, and our ED has adopted a conservative approach where safe for all PTX. Methods: We reviewed all T‐PTXs at our institution over a 7‐year period to assess outcomes of those conservatively managed and compare with those who received an ICC. A total of 144 cases were identified, 65 managed conservatively and 79 invasively. Each was individually reviewed and variables including demographics, aetiology, smoking/lung disease history, T‐PTX size (apical interpleural distance and hemithorax percentage), length of stay, Revised Trauma Score, Injury Severity Score and delayed intervention/complications were recorded. Chi‐squared, Z ‐score, Mann–Whitney U and t ‐tests were used for analysis. Results: The mean apical interpleural distance was 26.8 mm (95% confidence interval [CI] 22.1–29.7 mm) in the conservative group and 49.1 mm (95% CI 41.2–57.0 mm) in the ICC group ( P < 0.05 for difference between groups). Mean T‐PTX percentage 25.9% (95% CI 22.1–29.7%) in the conservative group versus 45.9% (95% CI 39.7–50.5%) in the ICC group ( P < 0.05 for difference between two groups) and mean Revised Trauma Score 7.4 (conservative) versus 6.8 (invasive) ( P < 0.05). No conservatively managed patient required a delayed intervention for their T‐PTX, and 2 of 79 (3%) patients in the ICC group had a complication (one infection, one haemothorax). Conclusion: Our data support conservative management of selected T‐PTXs and shows a need for a prospective randomised trial to further examine this intervention. Abstract : Traumatic pneumothoraces have traditionally been managed with an intercostal catheter. We present a dataset of conservatively managed traumatic pneumothoraces with safe outcomes and highlight the need for prospective randomised trials further investigating this.