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Blunt Traumatic Occult Pneumothorax: Is Observation Safe?-Results of a Prospective, AAST Multicenter Study.
MedLine Citation:
PMID:  21610419     Owner:  NLM     Status:  Publisher    
BACKGROUND:: An occult pneumothorax (OPTX) is found incidentally in 2% to 10% of all blunt trauma patients. Indications for intervention remain controversial. We sought to determine which factors predicted failed observation in blunt trauma patients. METHODS:: A prospective, observational, multicenter study was undertaken to identify patients with OPTX. Successfully observed patients and patients who failed observation were compared. Multivariate logistic regression was used to identify predictors of failure of observation. OPTX size was calculated by measuring the largest air collection along a line perpendicular from the chest wall to the lung or mediastinum. RESULTS:: Sixteen trauma centers identified 588 OPTXs in 569 blunt trauma patients. One hundred twenty-one patients (21%) underwent immediate tube thoracostomy and 448 (79%) were observed. Twenty-seven patients (6%) failed observation and required tube thoracostomy for OPTX progression, respiratory distress, or subsequent hemothorax. Fourteen percent (10 of 73) failed observation during positive pressure ventilation. Hospital and intensive care unit lengths of stay, and ventilator days were longer in the failed observation group. OPTX progression and respiratory distress were significant predictors of failed observation. Most patient deaths were from traumatic brain injury. Fifteen percentage of patients in the failed observation group developed complications. No patient who failed observation developed a tension PTX, or experienced adverse events by delaying tube thoracostomy. CONCLUSION:: Most blunt trauma patients with OPTX can be carefully monitored without tube thoracostomy; however, OPTX progression and respiratory distress are independently associated with observation failure.
Forrest O Moore; Pamela W Goslar; Raul Coimbra; George Velmahos; Carlos V R Brown; Thomas B Coopwood; Lawrence Lottenberg; Herb A Phelan; Brandon R Bruns; John P Sherck; Scott H Norwood; Stephen L Barnes; Marc R Matthews; William S Hoff; Marc A de Moya; Vishal Bansal; Charles K C Hu; Riyad C Karmy-Jones; Fausto Vinces; Karl Pembaur; David M Notrica; James M Haan
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Publication Detail:
Journal Detail:
Title:  The Journal of trauma     Volume:  70     ISSN:  1529-8809     ISO Abbreviation:  -     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-5-25     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376373     Medline TA:  J Trauma     Country:  -    
Other Details:
Languages:  ENG     Pagination:  1019-1025     Citation Subset:  -    
From the St. Joseph's Hospital & Medical Center (F.O.M., P.W.G.), Phoenix, Arizona; UCSD Medical Center (R.C., V.B.), San Diego, California; Massachusetts General Hospital (G.V., M.A.M.), Boston, Massachusetts; University Medical Center (C.V.R.B., T.B.C.) - Brackenridge, Austin, Texas; University of Florida Health Sciences Center (L.L.), Gainesville, Florida; UT-Southwestern Medical Center (H.A.P.), Dallas, Texas; University of Pennsylvania Medical Center (B.R.B.), Philadelphia, Pennsylvania; Santa Clara Valley Medical Center (J.P.S.), San Jose, California; East Texas Medical Center (S.H.N.), Tyler, Texas; University of Missouri (S.L.B.), Columbia, Missouri; Maricopa Medical Center (M.R.M.), Phoenix, Arizona; St. Luke's Hospital & Medical Center (W.S.H.), Bethlehem, Pennsylvania; Scottsdale Osborne Medical Center (C.K.C.H.), Scottsdale, Arizona; Southwest Washington Medical Center (R.C.K.-J.), Vancouver, Washington, DC; Lutheran Medical Center (F.V.), Brooklyn; Lutheran Medical Center (K.P.), Brooklyn, New York; Phoenix Children's Hospital (D.M.N.), Phoenix, Arizona; and Via Christi Regional Medical Center (J.M.H.), Wichita, Kansas.
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