title: The selective conservative management of small traumatic pneumothoraces following stab injuries is safe: experience from a high-volume trauma service in South Africa.
abstract: OBJECTIVE
  The selective conservative management of small pneumothoraces (PTXs) following stab injuries is controversial. We reviewed a cohort of patients managed conservatively in a high volume trauma service in South Africa.
  
  
  METHODS
  A retrospective review over a 2-year period identified 125 asymptomatic patients with small PTXs measuring <2 cm on chest radiograph who were managed conservatively.
  
  
  RESULTS
  Of the 125 patients included in the study, 92% were male (115/125), and the median age for all patients was 21 years (19-24). Ninety-seven per cent (121/125) of the weapons involved were knives, and 3% (4/125) were screwdrivers. Sixty-one per cent of all injuries were on the left side. Eighty-two per cent (102/125) sustained a single stab, and 18% (23/125) had multiple stabs. Thirty-nine per cent (49/125) had a PTX <0.5 cm (Group A), 26% (32/125) were ≥ 0.5 to <1 cm (Group B), 19% (24/125) were ≥ 1 to <1.5 cm (Group C) and 15% (20/125) were ≥ 1.5 to <2 cm (Group D). Three per cent of all patients (4/125) eventually required ICDs (one in Group C, three in Group D). All four patients had ICDs in situ for 24 h. The remaining 97% (121/125) were all managed successfully by active clinical observation alone. There were no subsequent readmissions, morbidity or mortality as a direct result of our conservative approach.
  
  
  CONCLUSIONS
  The selective conservative management of asymptomatic small PTXs from stab injuries is safe if undertaken in the appropriate setting.
authors.affiliation: Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu Natal, Pietermaritzburg, 3216, South Africa, victorywkong@yahoo.com.
authors.forename: V Y
authors.initials: VY
authors.lastname: Kong
authors.forename: G V
authors.initials: GV
authors.lastname: Oosthuizen
authors.forename: D L
authors.initials: DL
authors.lastname: Clarke
mesh_terms: D000328:Adult; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D007813:Laparotomy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D011030:Pneumothorax / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D013019:South Africa; D013898:Thoracic Injuries / Q000150:complications / Q000401:mortality / Q000628:therapy*; D013907:Thoracostomy / Q000379:methods; D014193:Trauma Centers; D014951:Wounds, Stab / Q000150:complications / Q000401:mortality / Q000628:therapy*