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Title: Conservative management of traumatic pneumothoraces: A retrospective cohort study
Authors: Gerhardy, Benjamin 
Liebenberg, Paul
Simpson , Graham 
Issue Date: 2022
Source: Gerhardy BC, Liebenberg P, Simpson G. Conservative management of traumatic pneumothoraces: A retrospective cohort study. Emerg Med Australas. 2022 Apr;34(2):194-198. doi: 10.1111/1742-6723.13846. Epub 2021 Aug 25. PMID: 34433229.
Journal: Emergency medicine Australasia : EMA
Abstract: Traumatic pneumothoraces (T-PTXs) are traditionally managed with an intercostal catheter (ICC), despite little evidence for this. Success with conservative management of primary spontaneous PTX has been demonstrated, and our ED has adopted a conservative approach where safe for all PTX. We reviewed all T-PTXs at our institution over a 7-year period to assess outcomes of those conservatively managed and compare with those who received an ICC. A total of 144 cases were identified, 65 managed conservatively and 79 invasively. Each was individually reviewed and variables including demographics, aetiology, smoking/lung disease history, T-PTX size (apical interpleural distance and hemithorax percentage), length of stay, Revised Trauma Score, Injury Severity Score and delayed intervention/complications were recorded. Chi-squared, Z-score, Mann-Whitney U and t-tests were used for analysis. The mean apical interpleural distance was 26.8 mm (95% confidence interval [CI] 22.1-29.7 mm) in the conservative group and 49.1 mm (95% CI 41.2-57.0 mm) in the ICC group (P < 0.05 for difference between groups). Mean T-PTX percentage 25.9% (95% CI 22.1-29.7%) in the conservative group versus 45.9% (95% CI 39.7-50.5%) in the ICC group (P < 0.05 for difference between two groups) and mean Revised Trauma Score 7.4 (conservative) versus 6.8 (invasive) (P < 0.05). No conservatively managed patient required a delayed intervention for their T-PTX, and 2 of 79 (3%) patients in the ICC group had a complication (one infection, one haemothorax). Our data support conservative management of selected T-PTXs and shows a need for a prospective randomised trial to further examine this intervention.
Description: Cairns & Hinterland Hospital and Health Service (CHHHS) affiliated authors: Benjamin C Gerhardy, Paul Liebenberg, Graham Simpson
DOI: 10.1111/1742-6723.13846
Keywords: conservative;pneumothorax;trauma
Type: Article
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