Is the 35mm occult pneumothorax rule for chest tube insertion following blunt isolated trauma generalizable to penetrating injury and the polytraumatized patient?

Abstract text (incl. references and figure legends)

Introduction: Chest tube placement may be safely avoided in stable patients with a small occult blunt traumatic pneumothorax less than 35mm on CT scan. We assess the generalizability of this "35mm rule" following penetrating injury and in the polytraumatized patient.

Materials & Methods: We reviewed the records of all stable injured patients with occult pneumothorax identified on CT scan at our urban Level 1 trauma center from 01/01/2018 to 01/01/2022. We excluded patients with hemothorax, those who underwent needle decompression or chest tube placement prior to CT scan, resuscitative thoracotomy, cardiopulmonary resuscitation, or cannulation for ECMO.. Patient demographics, arrival vital signs, mechanism of injury (blunt, penetrating or polytrauma), hospital length of stay were identified from our institutional trauma registry. The radial intrapleural distance (in mm) was measured on initial CT. We assessed the association of the 35mm rule with successful observation or subsequent failure (clinical decompensation requiring chest tube placement).

Results: Occult pneumothorax was identified on CT scan in 232 stable injured patients. Motor Vehicle Accidents accounted for 31%, pedestrians struck for 7.7%, falls for 19.4% and blunt assaults for 18.9%. Gunshot wounds (11.6%) or stab wounds (11.6%) were the cause of the penetrating injuries. Fifty-four patients (24%) were victims of penetrating trauma while 178 (76%) presented after blunt trauma. In patients with a pneumothorax

Conclusion: Observation of pneumothorax

Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.)

No