Occult Traumatic Pneumothorax: Is Routine Follow Up Chest X-ray Necessary?
Bishwajit Bhattacharya, Kevin Schuster, Rick O"Connor, Robert Becher, Kimberly A. Davis, Adrian A. Maung
Surgery, Yale School of Medicine, New Haven, Connecticut, United States
Objective - Examine the necessity of follow up chest x-rays for occult traumatic pneumothoraces. Design- Retrospective case series of occult traumatic pneumothoraces over a 7-year period (2013-2019). Setting- Urban Level 1 Trauma center. Patients- Inclusion criteria: Adult blunt trauma patients age 18 and older. Pneumothoraces seen on computed tomography scan (CT scan) but not on initial chest x-ray (CXR) Exclusion criteria: Patients that were intubated on admission, demonstrated subcutaneous emphysema on initial chest x-ray, patients with hemothorax on admission. Interventions (if any)- None. Main Outcome Measure- The need for intervention (chest tube or pigtail placement) for occult pneumothoraces. Results- A total of 364 (Mean age 47.8 years range 18-98 years, 64.6% male) patients were included in the series. Only 7 (1.9%) patients subsequently required an intervention for pneumothoraces. Age (p=0.456), sex (p=0.634), Injury severity score (ISS) (p=0.823), chest abbreviated injury score (AIS) (p=0.072) were not predictive of need for intervention. Six of seven that required intervention demonstrated clinical symptoms of pneumothorax progression. Conclusions- Routine chest x-ray for occult traumatic pneumothorax among select blunt trauma patients is not necessary and does not change clinical management. Obtaining a chest x-ray based on symptoms of pneumothorax progression may be a more effective utilization of resources.
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