title: Open pneumothorax: the spectrum and outcome of management based on Advanced Trauma Life Support recommendations.
abstract: BACKGROUND
  The current management of open pneumothorax (OPTX) is based on Advanced Trauma Life Support (ATLS) recommendations and consists of the application of a three-way occlusive dressing, followed by intercostal chest drain insertion. Very little is known regarding the spectrum and outcome of this approach, especially in the civilian setting.
  
  
  METHODS
  We conducted a retrospective review of 58 consecutive patients with OPTX over a four-year period managed in a high volume metropolitan trauma service in South Africa.
  
  
  RESULTS
  Of the 58 patients included, 95% (55/58) were male, and the mean age for all patients was 21 years. Ninety-seven percent of all injuries were inflicted by knives and the remaining 3% (2/58) of injuries were inflicted by unknown weapons. 59% of injuries were left sided. In six patients (10%) a protocol violation was present in their management. Five of the six patients (83%) in whom protocol violation occurred developed a life-threatening event (tension PTX) compared to none amongst those where the protocol was followed (p < 0.001). There was no mortality as a direct result of management of OPTX following ATLS recommendations.
  
  
  CONCLUSIONS
  ATLS recommendations for OPTX are safe and effective. Any deviation from this standard practice is associated with avoidable morbidity and potential mortality.
authors.affiliation: Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, Nelson R Mandela School of Medicine, University of KwaZulu Natal, Pietermaritzburg, South Africa, victorywkong@yahoo.com.
authors.forename: V Y
authors.initials: VY
authors.lastname: Kong
authors.forename: M
authors.initials: M
authors.lastname: Liu
authors.forename: B
authors.initials: B
authors.lastname: Sartorius
authors.forename: D L
authors.initials: DL
authors.lastname: Clarke
mesh_terms: D000328:Adult; D061906:Advanced Trauma Life Support Care / Q000592:standards*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004322:Drainage / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D009779:Occlusive Dressings; D011030:Pneumothorax / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D013019:South Africa; D015996:Survival Rate; D013898:Thoracic Injuries / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult