Hemopneumothorax missed by auscultation in penetrating chest injury.
OBJECTIVE
To determine the frequency and extent of hemothorax, pneumothorax, and hemopneumothorax missed by auscultation in penetrating chest injury.


METHODS
A retrospective chart and chest radiograph review.


METHODS
One hundred and eighteen patients suffering penetrating chest injuries during 1993 were studied. A missed auscultation was defined as a patient with normal breath sounds but shown by chest radiograph to have a hemothorax, pneumothorax, or hemopneumothorax. The amount of hemothorax was recorded after chest tube placement or at thoracotomy. The degree of pneumothorax was determined by Rhea's method.


RESULTS
Seventy-one patients (60%) had a hemothorax, pneumothorax, or hemopneumothorax. Auscultation to detect hemothorax, pneumothorax, or hemopneumothorax had a sensitivity of 58%, a specificity of 98%, and a positive predictive value of 98%. Thirty of 71 patients (42%) were found to have pleural space blood or air missed by auscultation. Twelve patients (41%) had a hemopneumothorax, 11 patients (36%) had hemothorax, and seven patients (23%) had pneumothorax. Auscultation missed hemothorax up to 600 mL, pneumothorax up to 28%, and hemopneumothorax up to 800 mL and 28%.


CONCLUSIONS
Hemopneumothorax and hemothorax are the conditions most likely to be missed by auscultation, especially in patients with gunshot wounds. Auscultation has a high positive predictive value because it indicates injury with a fair degree of certainty; however, a negative auscultation does not rule out injury.
Chen
S C
SC
Department of Emergency Medicine, National Taiwan University Hospital, Taipei.
Markmann
J F
JF
Kauder
D R
DR
Schwab
C W
CW
D000293:Adolescent; D000328:Adult; D001314:Auscultation; D003951:Diagnostic Errors; D005260:Female; D006468:Hemopneumothorax / Q000175:diagnosis*; D006491:Hemothorax / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000175:diagnosis*; D013898:Thoracic Injuries / Q000175:diagnosis*; D014948:Wounds, Gunshot / Q000175:diagnosis; D014950:Wounds, Penetrating / Q000175:diagnosis