Bhattacharya Bishwajit, O'Connor Rick, Becher Robert D, Schuster Kevin M, Davis Kimberly A, Maung Adrian A
Yale School of Medicine, 330 Cedar Street BB310, New Haven, CT 06510, United States.
Surg Pract Sci. 2022 Mar 17;9:100073. doi: 10.1016/j.sipas.2022.100073. eCollection 2022 Jun.
Occult pneumothoraces (OPTX) are pneumothoraces that are not seen on chest X-ray (CXR) but visualized on computerized tomography (CT) scan. OPTX are frequently discovered during the initial trauma evaluation, there is a paucity of evidence based guidelines on how they should be further monitored. In this study we hypothesized that the practice of obtaining routine CXR for the surveillance of OPTX does not alter clinical management.
We retrospectively analyzed all adult (18 years or older) patients with a traumatic (blunt and penetrating) OPTX over a 7-year period (2013-2019) evaluated at an academic, Level 1, urban trauma center. Patient demographics mechanism of injury were abstracted. We examined subsequent radiographic and clinical evolution of OPTX as well as the need for intervention.
363 patients were included in the series. Mean age was 47.8 years (range 18-98), 64.6% of the patients were male. Only 7 (1.9%) patients subsequently required an intervention for an OPTX. Neither age, sex, Injury severity score (ISS), or chest abbreviated injury score (AIS) ( = 0.072) were predictive of the need for intervention. Six of the seven patients that required intervention demonstrated clinical symptoms of pneumothorax progression.
In our experience the practice of obtaining routine chest X-rays for monitoring OPTX did not change clinical management. Obtaining a chest X-ray based on symptoms may be a more effective utilization of resources.
隐匿性气胸（OPTX）是指在胸部X线（CXR）上未见但在计算机断层扫描（CT）上可见的气胸。OPTX常在初始创伤评估时被发现，但关于如何进一步监测它们的循证指南却很少。在本研究中，我们假设获取常规CXR用于监测OPTX的做法不会改变临床管理。
我们回顾性分析了在一所学术性的一级城市创伤中心接受评估的所有成年（18岁及以上）创伤性（钝性和穿透性）OPTX患者，时间跨度为7年（2013 - 2019年）。提取了患者的人口统计学数据和损伤机制。我们检查了OPTX随后的影像学和临床演变以及干预需求。
该系列纳入了363例患者。平均年龄为47.8岁（范围18 - 98岁），64.6%的患者为男性。只有7例（1.9%）患者随后因OPTX需要干预。年龄、性别、损伤严重程度评分（ISS）或胸部简明损伤评分（AIS）（= 0.072）均不能预测干预需求。7例需要干预的患者中有6例表现出气胸进展的临床症状。
根据我们的经验，获取常规胸部X线用于监测OPTX的做法并未改变临床管理。根据症状进行胸部X线检查可能是更有效的资源利用方式。
