NEW YORK (Reuters Health) – In cases of traumatic occult pneumothorax, observation is apparently just as safe as the usual practice of immediate tube thoracostomy, according to a report in an online issue of Resuscitation.
“In an era when comparative effectiveness research is becoming widely recognized as important,” lead author Dr. Kabir Yadav commented in an email to Reuters Health, “it is crucial to evaluate the effectiveness, benefits, and harms of different treatment options, especially those things that we consider ‘common practice’ but have never properly examined.”
Dr. Yadav at George Washington University in Washington, DC and colleagues evaluated the necessity of the common intervention of tube thoracostomy in patients who have post-injury occult pneumothorax, i.e., pneumothorax that is not identified on the initial chest radiography but is seen on CT scan.
A literature search identified over 400 relevant article comparing management strategies, of which 3 randomized trials involving a total of 101 patients had acceptable quality standards suitable for analysis.
“Our review of the literature showed that hospital observation alone, without a chest tube could yield the same results as far as patient-oriented outcomes are concerned,” Dr. Yadav said.
Specifically, comparing observation to tube thoracostomy, the relative risks of pneumothorax progression, development of pneumonia, development of empyema, and mortality were not significantly different.
While they conclude that observation is a safe option in this setting, the researchers acknowledge that several non-clinical factors “might impact the physicians’ decision to manage occult pneumothorax.” These include the availability of proper follow-up after discharge, and patient preferences after being informed of the pros and cons.
In the conclusion of their report, the authors also caution that there is inadequate evidence “to draw any definitive conclusion on safety of expectant management in patients with occult pneumothorax that undergo positive pressure ventilation.”
Management of traumatic occult pneumothorax