title: Observation period for asymptomatic penetrating chest trauma: 1 or 3 h?
abstract: BACKGROUND
  Current recommendations for evaluation and safe discharge of penetrating chest trauma patients regarding pneumothorax (PTX) include a Chest X Ray (CXR) at the Emergency Department (ED) upon arrival and second CXR after 3 h if the first one is negative.
  
  
  OBJECTIVE
  To compare CXRs taken at the first and third hours of ED arrival and evaluate a 1 h period of observation instead of 3 h for safe discharge of patients with penetrating chest trauma.
  
  
  METHODS
  In this cross-sectional study, all asymptomatic patients with penetrating chest trauma referred to a level 1 trauma center with negative initial Postero-Anterior (PA) CXRs (hour 0) were enrolled. Those with intoxication, tube thoracostomy, chest computed tomography, evidence of abdominal penetration, an overall elapsed timed of more than 1 h for admission to the ED, and refusal to take part in the study were excluded. Patients underwent subsequent PA CXRs at hours 1 and 3. A phone call follow up after 24 h was organized for each patient.
  
  
  RESULTS
  A total of 68 patients were enrolled. There was 100 % concordance among CXRs performed at hours 1 and 3 in the study population. None of the patients showed clinical deterioration or PTX in CXR at hour 1 if remained asymptomatic during the first hour of observation.
  
  
  CONCLUSIONS
  Asymptomatic patients with penetrating chest trauma, negative initial PA CXR, no signs of intoxication, and no deterioration during the first hour of observation may be considered for discharge. Further evidence is required to make recommendations based on these findings.
authors.affiliation: Department of Emergency Medicine, Bahonar Academic Hospital, Kerman University of Medical Sciences, Kerman, Iran.
authors.forename: L
authors.initials: L
authors.lastname: Seidzadeh Gooklan
authors.affiliation: Department of Emergency Medicine, Bahonar Academic Hospital, Kerman University of Medical Sciences, Kerman, Iran.
authors.forename: A
authors.initials: A
authors.lastname: Yari
authors.affiliation: Department of Emergency Medicine, Bahonar Academic Hospital, Kerman University of Medical Sciences, Kerman, Iran.
authors.forename: M
authors.initials: M
authors.lastname: Mayel
authors.affiliation: Department of Radiology, Kerman University of Medical Sciences, Kerman, Iran.
authors.forename: S
authors.initials: S
authors.lastname: Nazemi
authors.affiliation: Department of Emergency Medicine, Bahonar Academic Hospital, Kerman University of Medical Sciences, Kerman, Iran.
authors.forename: M
authors.initials: M
authors.lastname: Movahedi
authors.affiliation: Department of Emergency Medicine, Bahonar Academic Hospital, Kerman University of Medical Sciences, Kerman, Iran. a.mirafzal@yahoo.com.
authors.forename: A
authors.initials: A
authors.lastname: Mirafzal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002985:Clinical Protocols; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007492:Iran; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011030:Pneumothorax / Q000000981:diagnostic imaging*; D013898:Thoracic Injuries / Q000000981:diagnostic imaging*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014950:Wounds, Penetrating / Q000000981:diagnostic imaging*; D055815:Young Adult
keywords: Observation period; Penetrating chest trauma