Thoracic CT findings and patient demographics associated with traumatic pneumothorax: recommendations for the emergency department.

BACKGROUND

People with thoracic trauma often present to the emergency department with low-energy injuries and sustain rib fractures. This study aimed to assess the risk of traumatic pneumothorax in a patient cohort based on the radiological characteristics of rib fractures, along with patient and environmental variables.

METHODS

We conducted a retrospective analysis of demographic characteristics, the number and nature of rib fractures, the date of trauma, and the correlation between pneumothorax and rib fractures in patients treated in the thoracic surgery departments of three centers between May 2021 and August 2024.

RESULTS

Gender, side of trauma, location of the rib fracture, and season were not found to correlate with traumatic pneumothorax. The probability of pneumothorax reduced by 2.1% with each 1-year increase in age (OR = 0.979; p = 0.006). Each fractured rib increased the incidence of traumatic pneumothorax by 23% (OR = 1.23; p = 0.011). Patients with at least one displaced rib fracture had a 2.08-fold higher incidence of traumatic pneumothorax compared to those without displaced rib fractures (OR = 2.08; p = 0.016). The cut-off number of rib fractures associated with traumatic pneumothorax was determined to be 3.5.

CONCLUSIONS

Young patients arriving at the emergency room with acute thoracic trauma, those with at least one displaced rib fracture, and individuals with four or more rib fractures are at risk for traumatic pneumothorax. Patients exhibiting these features should be evaluated by thoracic surgery specialists in the emergency department.