Can Concurrent Traumatic Hemopneumothorax be Safely Observed?

Area of Science:

• Trauma surgery
• Thoracic surgery
• Emergency medicine

Background:

• Concurrent traumatic hemothorax (HTX) and pneumothorax (PTX) occur in 70% of cases.
• Observing small isolated HTX (≤300 cc) and PTX (≤35 mm) is safe.
• The safety of observing concurrent small hemopneumothorax (HPTX) requires assessment.

Purpose of the Study:

• To assess the safety and outcomes of initial observation for concurrent small traumatic HPTX.
• To compare initial observation versus early tube thoracostomy (TT) for HPTX.

Main Methods:

• Retrospective study (2015-2021) at a level I trauma center.
• Included patients with CT-confirmed HPTX; excluded those with prior TT, TT for rib fixation, PTX >35 mm, HTX >300 cc, or death within 72 hours.
• Stratified patients into initial observation or early TT groups; primary outcome was observation failure.

Main Results:

• 353 patients met criteria; 261 (74%) were initially observed.
• Observation group had lower pulmonary morbidity (9% vs. 14%) and shorter hospital (7 vs. 10 days) and ICU (2 vs. 4 days) stays.
• Observation failure occurred in 68 patients (26%), most commonly due to worsening HTX (45%); failed observation patients had similar outcomes to the early TT group.

Conclusions:

• Initial observation of small concurrent traumatic HPTX is associated with reduced pulmonary morbidity and length of stay.
• A clinically significant failure rate exists for observation, with outcomes comparable to early tube thoracostomy.
• Observation is a safe initial approach, but careful monitoring is essential due to the failure rate.