The following is a summary of “Comparison of outcomes between observation and tube thoracostomy for small traumatic pneumothoraces,” published in the April 2023 issue of Emergency Medicine by Banks, et al.

The management of traumatic pneumothorax has evolved to include smaller tube thoracostomy or observation alone. However, limited data are available comparing the efficacy of these management strategies for small traumatic pneumothoraces. Therefore, for a study, researchers sought to investigate whether observing patients with a small traumatic pneumothorax on initial chest radiograph (CXR) was associated with improved outcomes compared to tube thoracostomy.

The retrospective study reviewed trauma patients from January 1, 2016, to December 31, 2020, at a level 1 trauma center. Patients with a pneumothorax size <30 mm measured from apex to cupola on initial CXR were included, while those with injury severity score ≥ 25, operative requirements, hemothorax, bilateral pneumothoraces, and intensive care unit admission were excluded. Patients were grouped by management strategy (observation vs. tube thoracostomy), and outcomes were compared.

Of the eligible patients, 39 were in the observation group, and 34 were in the tube thoracostomy group. Baseline characteristics were similar between the groups. The average pneumothorax size on CXR was similar between the groups (observation: 18 ± 1.0 mm, tube thoracostomy: 18 ± 0.84 mm) (P > 0.99). However, the average pneumothorax sizes on computed tomography were significantly different between the groups (observation: 25 ± 2.1 mm, tube thoracostomy: 37 ± 3.9 mm, P = 0.01). The length of stay was significantly shorter in the observation group than in the tube thoracostomy group (3.6 ± 0.33 vs. 5.8 ± 0.81 days, P < 0.01). Only tube thoracostomy correlated with length of stay on multivariable analysis. There were no deaths or readmissions in either cohort. One patient in the observation group required tube thoracostomy after 18 hours, and one patient in the tube thoracostomy group developed an empyema.

For select patients with small traumatic pneumothoraces on initial CXR, an observation-first strategy is associated with a shorter length of stay than tube thoracostomy. The outcomes were similar between the two groups, suggesting that an observation-first strategy may be a superior treatment approach for these patients.

Reference: https://www.sciencedirect.com/science/article/pii/S0735675723000189