Document Detail

Occult pneumothoraces in patients with penetrating trauma: Does mechanism matter?
MedLine Citation:
PMID:  20646399     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Supine anteroposterior (AP) chest radiography is an insensitive test for detecting posttraumatic pneumothoraces (PTXs). Computed tomography (CT) often identifies occult pneumothoraces (OPTXs) not diagnosed by chest radiography. All previous literature describes the epidemiology of OPTX in patients with blunt polytrauma. Our goal was to identify the frequency of OPTXs in patients with penetrating trauma.
METHODS: All patients with penetrating trauma admitted over a 10-year period to Grady Memorial Hospital with a PTX were identified. We reviewed patients' thoracoabdominal CT scans and corresponding chest radiographs.
RESULTS: Records for 1121 (20%) patients with a PTX (penetrating mechanism) were audited; CT imaging was available for 146 (13%) patients. Of these, 127 (87%) had undergone upright chest radiography. The remainder (19 patients) had a supine AP chest radiograph. Fifteen (79%) of the PTXs detected on supine AP chest radiographs were occult. Only 10 (8%) were occult when an upright chest radiograph was used (p < 0.001). Posttraumatic PTXs were occult on chest radiographs in 17% (25/146) of patients. Fourteen (56%) patients with OPTXs underwent tube thoracostomy, compared with 95% (115/121) of patients with overt PTXs (p < 0.001).
CONCLUSION: Up to 17% of all PTXs in patients injured by penetrating mechanisms will be missed by standard trauma chest radiographs. This increases to nearly 80% with supine AP chest radiographs. Upright chest radiography detects 92% of all PTXs and is available to most patients without spinal trauma. The frequency of tube thoracostomy use in patients with overt PTXs is significantly higher than for OPTXs in blunt and penetrating trauma.
Chad G Ball; Christopher J Dente; Andrew W Kirkpatrick; Amit D Shah; Ravi R Rajani; Amy D Wyrzykowski; Gary A Vercruysse; Grace S Rozycki; Jeffrey M Nicholas; Jeffrey P Salomone; David V Feliciano
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Canadian journal of surgery. Journal canadien de chirurgie     Volume:  53     ISSN:  1488-2310     ISO Abbreviation:  Can J Surg     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-07-21     Completed Date:  2010-09-21     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  0372715     Medline TA:  Can J Surg     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  251-5     Citation Subset:  IM    
Department of Surgery, Grady Memorial Hospital, Emory University, Atlanta, Ga., USA.
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MeSH Terms
Chest Tubes
Drainage / instrumentation*
Follow-Up Studies
Pneumothorax / etiology*,  radiography,  surgery
Radiography, Thoracic
Retrospective Studies
Thoracic Injuries / complications*,  radiography,  surgery
Thoracostomy / methods*
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Wounds, Penetrating / complications*,  radiography,  surgery

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