Management of the asymptomatic patient with a stab wound to the chest

We prospectively studied 126 asymptomatic patients who had a total of 144 stab wounds (average size, 2 cm) to the chest to determine their need for hospitalization. Their average age was 32 years; 102 of them were men. Four left against medical advice. The remaining 122 patients were judged to be asymptomatic when inspiratory and expiratory chest roentgenograms, recorded serially over a 24-hour period, revealed no intrathoracic trauma. Subcutaneous air was found in five of the patients, and an aorto-right ventricular fistula was found in one patient during his follow-up visit to the clinic a week later. The fistula was repaired uneventfully. No late-developing complications were detected in a review of the charts a year later. We believe a patient with a stab wound to the chest but with no evidence of intrathoracic injury may be appropriately managed with limited observation, including serial inspiratory and expiratory roentgenograms of the chest.