J Korean Soc Emerg Med.  2024 Dec;35(6):377-383.

The clinical analysis of traumatic occult pneumothorax in the emergency room

• Shin CM
• Lee SK
• Joo SH
• Kim SP

Abstract

Objective
Traumatic occult pneumothorax is defined as a pneumothorax that cannot be identified with a simple chest X-ray and can be detected only by chest computed tomography (CT). The purpose of this study was to retrospectively recognize the difference between thoracostomy and conservative treatment of traumatic occult pneumothorax.
Methods
Among the thoracic trauma inpatients who visited a single emergency room (ER) from January 2021 to May 2022, adult patients aged over 18 years, diagnosed with traumatic pneumothorax who survived their ER stay and with abnormalities were included as the final study subjects and their histories were compared.
Results
Of the total of 269 thoracic trauma patients, 110 were diagnosed with traumatic pneumothorax, of which 30 were traumatic occult pneumothorax patients. Multiple logistic regression analyses performed in the traumatic occult pneumothorax patient group showed that as the pneumothorax size increased, the probability of finding an occult pneumothorax decreased (odds ratio [OR]=0.93; 95% confidence interval [CI], 0.89-0.98). In very severe cases of rib fractures (OR=0.65; 95% CI, 0.43-0.98), the probability of detecting occult pneumothorax was reduced. Among the patients with traumatic occult pneumothorax, 15 patients underwent thoracostomy. Cases of hemothorax (70%; P=0.05), surgery (26.67%; P<0.01), and higher injury severity scores (12.87±7.69; P=0.02) were more common in the thoracostomy group.
Conclusion
Usually traumatic occult pneumothorax is treated conservatively with regular follow-up, but thoracostomy is necessary when it is accompanied by hemothorax and for patients requiring surgery and having a higher injury severity score.

Keyword

Thoracic trauma; Occult; Pneumothorax; Thoracotomy