Factors Associated with Chest Tube Placement in Blunt Trauma Patients with an Occult Pneumothorax

Author:

Paplawski Michael1,Munnangi Swapna1ORCID,Digiacomo Jody C.1,Gonzalez Edwin1,Modica Ashley2,Tung Shawndeep S.3,Ko Catherine4

Affiliation:

1. Department of Surgery, Nassau University Medical Center, East Meadow, NY, USA

2. Department of Plastic Surgery, University of South Florida Morsani School of Medicine, Tampa, FL, USA

3. Banner MD Anderson Cancer Center, Sun City West, AZ, USA

4. Doctors Center, Bridgeport, CT, USA

Abstract

Background. An occult pneumothorax is identified by computed tomography but not visualized by a plain film chest X-ray. The optimal management remains unclear.Methods. A retrospective review of an urban level I trauma center’s trauma registry was conducted to identify patients with occult pneumothorax over a 2-year period. Factors predictive of chest tube placement were identified using univariate and multivariate logistic regression analysis.Results. A total of 131 patients were identified, of whom 100 were managed expectantly with an initial period of observation. Ultimately, 42 (32.0%) patients received chest tubes and 89 did not. The patients who received chest tubes had larger pneumothoraces at initial assessment, a higher incidence of rib fractures, and an increased average number of rib fractures, of which significantly more were displaced.Conclusions. Displaced rib fractures and moderate-sized pneumothoraces are significant factors associated with chest tube placement in a victim of blunt trauma with occult pneumothorax. The optimal timing for the first follow-up chest X-ray remains unclear.

Publisher

Hindawi Limited

Subject

Critical Care and Intensive Care Medicine

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