Non-Invasive Management of Blunt Traumatic Pneumothorax-a Meta-Analysis

Traumatic pneumothoraces occur in 25% of patients sustaining traumatic chest injury. Tube thoracostomy carries a risk of major complications leading to the necessity of tube thoracostomy insertion for traumatic pneumothoraces to be challenged.

This meta-analysis analyses current evidence relating to the management of traumatic pneumothorax and synthesises the evidence to determine whether clinicians can safely omit tube thoracostomy in patients with traumatic pneumothorax presenting to the Emergency Department (ED).

This meta-analysis was performed by searching electronic databases. Papers were included for analysis if they used patients sustaining blunt trauma and compared tube thoracostomy to conservative management. Comparisons were made for those undergoing tube thoracostomy and those undergoing conservative management.

Fourteen studies comprising 1550 patients were included. There is a non-significant combined pneumothorax progression rate of 12% for those observed, and 7.6% for those with a tube thoracostomy (p = 0.8447) with an odds ratio of 1.33. There was an 11.9% rate for tube thoracostomy insertion among patients observed, and a 10.4% requirement for further tube thoracostomy placement in those already with a tube thoracostomy (p = 0.3436) with an odds ratio of 0.553. For patients receiving positive pressure ventilation, the rates were 18% in observed patients compared to 9% of those with a tube thoracostomy (p = 0.2848) with an odds ratio of 4.123.

Conservative management of traumatic pneumothorax without positive pressure ventilation is a reasonable initial safe approach in the ED. Only ~12% of these patients will eventually require a tube thoracostomy.