title: The selective conservative management of penetrating thoracic trauma is still appropriate in the current era.
abstract: BACKGROUND
  Traumatic pleural collections secondary to penetrating chest trauma are generally managed by intercostal chest drainage (ICD), but these protocols were developed a few decades ago when stabs (SWs) predominated over gunshot wounds (GSWs). This study reviews the outcome of a selective conservative approach to penetrating thoracic trauma to establish if it is still appropriate in the current era.
  
  
  METHODS
  We reviewed 827 patients over a four-year period with penetrating unilateral non-cardiac wounds of the chest in order to review the efficacy of our policy and to define the differences in the spectrum of injury between SWs and GSWs.
  
  
  RESULTS
  Ninety-two per cent (764/827) were males, and the median age was 24 years. Seventy-six per cent (625/827) sustained SWs and twenty-four per cent (202/827) GSWs. Chest pathologies were: pneumothorax (PTX): 362 (44%), haemothorax (HTX): 150 (18%) and haemopneumothorax (HPTX): 315 (38%). Ninety-six per cent of patients were managed non-operatively. Four per cent (36/827) were subjected to a thoracotomy [31 SWs and 5 GSWs]. No difference was observed in terms of the need for operative intervention: 5% vs. 3% [p=0.202]. PTX was seen exclusively in SWs: 58% vs. 0% and there were significantly more HPTXs seen in the GSWs: HPTX: 24% vs. 81% [p<0.001]. The median days of ICD in situ were significantly longer in GSWs compared to SWs for all pathologies. For HTX: 4.5 (interquartile range [IQR]: 3-6) vs. 3.5 (IQR: 0-5) days, p=0.001 and HPTX: 4 (IQR: 3-5) vs. 3.0 (IQR: 3-4) days, p<0.001. There were seven (15%) complications. A total of five (13%) patients died and all deaths were confined to the operative group.
  
  
  CONCLUSIONS
  SWs continue to predominate over GSWs. PTXs were more commonly associated with SWs, whilst HPTX are more commonly associated with GSWs. A policy of selective conservatism is still applicable to the management of traumatic pleural collections.
authors.affiliation: Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu Natal, Pietermaritzburg 3216, South Africa. Electronic address: victorywkong@yahoo.com.
authors.forename: Victor Y
authors.initials: VY
authors.lastname: Kong
authors.affiliation: Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa. Electronic address: sartorius@ukzn.ac.za.
authors.forename: Benn
authors.initials: B
authors.lastname: Sartorius
authors.affiliation: Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu Natal, Pietermaritzburg 3216, South Africa. Electronic address: damianclar@gmail.com.
authors.forename: Damian L
authors.initials: DL
authors.lastname: Clarke
mesh_terms: D000328:Adult; D000465:Algorithms; D015505:Chest Tubes; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011030:Pneumothorax / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D015995:Prevalence; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D013898:Thoracic Injuries / Q000150:complications / Q000401:mortality / Q000601:surgery*; D013907:Thoracostomy / Q000379:methods*; D016896:Treatment Outcome; D014948:Wounds, Gunshot / Q000150:complications / Q000401:mortality / Q000601:surgery*; D014951:Wounds, Stab / Q000150:complications / Q000401:mortality / Q000601:surgery*
keywords: Gunshot; Penetrating; Stab; Thoracic trauma