title: Traumatic tension pneumothorax: experience from 115 consecutive patients in a trauma service in South Africa.
abstract: BACKGROUND
  Traumatic tension pneumothorax (TPTX) is a life threatening condition, but literature describing this condition specifically in developing countries is scarce.
  
  
  METHODS
  We conducted a retrospective review of 115 patients with a TPTX, managed over a 4-year period in a high volume trauma service in South Africa.
  
  
  RESULTS
  A total of 118 TPTXs were identified in 115 patients. Eighty-nine percent (102/115) were males, and the mean age was 26 years (SD ± 6 years). Seventy-four percent (87/118) of all TPTXs occurred on the left side. The mechanisms of injury were penetrating in 71 % (82/115) [82 stab injuries], and blunt in 29 % (33/115) [31 road traffic accidents and 2 assaults]. Ninety-seven percent (111/115) of patients presented directly to our unit, while 3 % (4/115) were referrals from other hospitals. Fifteen percent (17/115) of needle decompressions were performed in the pre-hospital setting while the remaining 85 % (98/115) were performed on arrival (73 were recognised clinically and 25 were not). Of the 25 TPTXs that were not recognised clinically on initial assessment, 12 were discovered on CXR, 8 on CT scans and 5 in the operating room (OR). The overall mortality was 9 % (10/115) [7 in CXR, 2 in CT, 1 in OR]. None of the patients who had the TPTXs identified on initial clinical assessment died (0/73), compared with those who were missed on initial clinical assessment, in which the mortality was significantly higher at 40 % (10/25), (p < 0.001).
  
  
  CONCLUSIONS
  Penetrating injuries accounted for the majority of TPTXs seen in our setting. Clinical recognition of the entity may be challenging and delayed recognition is associated with significant mortality.
authors.affiliation: Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu Natal, Pietermaritzburg, South Africa. victorywkong@yahoo.com.
authors.forename: V
authors.initials: V
authors.lastname: Kong
authors.affiliation: Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu Natal, Durban, South Africa. sartorius@ukzn.ac.za.
authors.forename: B
authors.initials: B
authors.lastname: Sartorius
authors.affiliation: Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu Natal, Pietermaritzburg, South Africa. damianclar@gmail.com.
authors.forename: D
authors.initials: D
authors.lastname: Clarke
mesh_terms: D000328:Adult; D015331:Cohort Studies; D019299:Decompression, Surgical; D003951:Diagnostic Errors; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D011030:Pneumothorax / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D013019:South Africa; D013898:Thoracic Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D013907:Thoracostomy; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D014950:Wounds, Penetrating / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D055815:Young Adult
keywords: Decompression; Penetrating injuries; Traumatic tension pneumothorax