title: Reliability of physical examination in penetrating chest injuries.
abstract: The decision to insert an intercostal drain in chest injury must occasionally be made without a chest radiograph. A prospective analysis of the reliability of physical examination in penetrating pleural injuries was undertaken. A total of 51 consecutive patients were examined before obtaining a chest radiograph. The presumptive diagnosis and decision to institute intercostal drainage were compared with the radiological diagnosis and the actual decision in each patient. A policy of selective drainage of large pleural collections was employed. The series consisted mainly of stab injuries in young men. Physical examination accurately diagnosed 13 of the 14 large pneumo- or haemothoraces. This reliability combined with the selective drainage policy showed that physical examination accurately predicted the need for tube thoracostomy with a sensitivity of 96 per cent and a specificity of 93 per cent. This study suggests that experienced clinicians should not hesitate to institute immediate life-saving intercostal drainage when needed, before a chest radiograph is obtained.
authors.affiliation: Department of Surgery, University of Natal, Durban, South Africa.
authors.forename: A
authors.initials: A
authors.lastname: Hirshberg
authors.forename: S R
authors.initials: SR
authors.lastname: Thomson
authors.forename: W K
authors.initials: WK
authors.lastname: Huizinga
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004322:Drainage; D005260:Female; D006468:Hemopneumothorax / Q000175:diagnosis; D006491:Hemothorax / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D010994:Pleura / Q000293:injuries; D011030:Pneumothorax / Q000175:diagnosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D013898:Thoracic Injuries / Q000175:diagnosis*; D014950:Wounds, Penetrating / Q000175:diagnosis*