The Efficacy of CT Scan and the Optimal Treatment for Traumatic Occult Pneumothorax

ABSTRACT

PURPOSE: An unrecognized pneumothorax detected on chest and abdomen CT scan after chest blunt trauma is associated with the prognosis for the patient. We assessed the efficacy of chest CT scan and the optimal treatment for traumatic occult pneumothorax patients. METHODS: The charts and the chest radiographic data of all trauma patients diagnosed with traumatic occult pneumothorax from January 2000 through December 2003 at Ilsan Paik hospital were retrospectively reviewed. Data recorded included age, gender, injury mechanism, associated injuries, length of stay, revised trauma score (RTS), injury severity score (ISS), the type of pneumothorax, the course during the hospital, and whether the use of mechanical ventilation and general anesthesia. RESULTS: A total of 67 patients with traumatic occult pneumothorax were admitted over a 48-month period via the emergency department. Of the 67 patients, 39 patients (58.2%) had closed thoracostomy. The mean RTS was 11.21+/-1.45, and the mean ISS was 20.46 +/-12.52 in closed thoracostomy patients. In other 28 patients, the mean RTS was 11.64+/-1.12, and the mean ISS was 19.64 +/-11.25. In the closed thoracostomy groups, 10 patients (14.9%) needed mechanical ventilation or general anesthesia. In the other group, 3 patients needed it. CONCLUSION: CT scanning provided important information for finding traumatic occult pneumothorax. If anterolateral type pneumothorax is present, or highly positive mechanical ventilation is needed, the patients must be treated with closed thoracostomy. However when the occult pneumothorax has minimal size or general anesthesia is needed, patients can be safely observed and should be treated with a selective approach.