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

Michael Paplawski; Swapna Munnangi; Jody C Digiacomo; Edwin Gonzalez; Ashley Modica; Shawndeep S Tung; Catherine Ko

doi:10.1155/2019/9274697

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

Crit Care Res Pract. 2019 Sep 2:2019:9274697. doi: 10.1155/2019/9274697. eCollection 2019.

Authors

Michael Paplawski¹, Swapna Munnangi¹, Jody C Digiacomo¹, Edwin Gonzalez¹, Ashley Modica², Shawndeep S Tung³, Catherine Ko⁴

Affiliations

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.