Detection of occult pneumothoraces on abdominal computed tomographic scans in trauma patients.
BACKGROUND
An unrecognized, or occult, injury is particularly dangerous in trauma patients, who often have multiple life-threatening injuries. We sought to determine the frequency and quantify the utility of the abdominal computed tomographic (CT) scan in detecting occult pneumothoraces.


METHODS
Charts of all trauma patients diagnosed with a pneumothorax over a 7-year period were retrospectively reviewed for findings on admission chest radiograph, abdominal CT scan, and other demographic data.


RESULTS
A total of 312 charts were reviewed, with 230 patients identified as having a pneumothorax at admission. Of the 230 patients, 126 (54.8%) had an occult pneumothorax identified on abdominal CT scan. In these patients, the mean Trauma Score was 14.1 +/- 2.9 and the mean Injury Severity Score was 24.1 +/- 11.2. In the group of occult pneumothoraces, 84 (66.7%) underwent chest tube placement.


CONCLUSIONS
Abdominal CT scanning provided important information about thoracic trauma often missed on initial evaluation in the trauma bay. This information frequently affected the patient's clinical management.
Neff
M A
MA
Department of Surgery, York Hospital, Pennsylvania, USA. research@yorkhospital.edu
Monk
J S
JS
Peters
K
K
Nikhilesh
A
A
D000007:Abdominal Injuries / Q000000981:diagnostic imaging*; D000328:Adult; D005260:Female; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D008499:Medical Records; D009104:Multiple Trauma / Q000000981:diagnostic imaging*; D010414:Pennsylvania / Q000453:epidemiology; D011030:Pneumothorax / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000592:standards*