Occult pneumothorax in trauma patients

Development of an objective scoring system

Marc A. De Moya, Christopher Seaver, Konstantinos Spaniolas, Kenji Inaba, Michael Nguyen, Yevgeniy Veltman, David V Shatz, Hasan B. Alam, Louis Pizano

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

BACKGROUND: The incidence of occult pneumothorax (OPTX) has dramatically increased since the widespread use of computed tomography (CT) scanning. The OPTX is defined as a pneumothorax not identified on plain chest X-ray but detected by CT scan. The overall reported incidence is about 5% to 8% of all trauma patients. We conducted a 5-year review of our OPTX incidence and asked if an objective score could be developed to better quantify the OPTX. This in turn may guide the practitioner with the decision to observe these patients. METHODS: This is a retrospective review of all trauma patients in a Level I university trauma center during a 5-year period. The patients were identified by a query of all pneumothoraces in our trauma registry. Those X-ray results were then reviewed to identify those who had OPTX. After developing an OPTX score on a small number, we retrospectively scored 50 of the OPTXs by taking the largest perpendicular distance in millimeters from the chest wall of the largest air pocket. We then added 10 or 20 to this if the OPTX was either anterior/posterior or lateral, respectively. RESULTS: A total of 21,193 trauma patients were evaluated and 1,295 patients with pneumothoraces (6.1%) were identified. Of the 1,295 patients with pneumothoraces, 379 (29.5%) OPTXs were identified. The overall incidence of OPTX was 1.8%: 95.7% occurred after blunt trauma, 222 (59%) of the OPTX patients had chest tubes and of the remaining 157 without chest tubes, 27 (17%) were on positive pressure ventilation. Of the 50 studies selected for scoring, the average score was 28.5. The average score for those with chest tubes was 34. The average score for those without chest tubes was 21. The positive predictive value for need of chest tube if the score was >30 was 78% and the negative predictive value if the score was <20 was 70%. Area under the receiver operator characteristic curve was 0.72, which was significant with p < 0.007. CONCLUSIONS: The OPTX score could quantify the size of the OPTX allowing the practitioner to better define a "small" pneumothorax. The management of OPTX is not standardized and further study using a more objective classification may assist the surgeon's decision-making. The application of a scoring system may also decrease unnecessary insertion of chest tubes for small OPTXs and is currently being prospectively validated.

Original languageEnglish (US)
Pages (from-to)13-17
Number of pages5
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume63
Issue number1
DOIs
StatePublished - Jul 2007
Externally publishedYes

Fingerprint

Pneumothorax
Wounds and Injuries
Chest Tubes
Incidence
X Ray Computed Tomography
Positive-Pressure Respiration
Trauma Centers
Thoracic Wall

Keywords

  • Occult pneumothorax
  • Pneumothorax
  • Pneumothorax scoring
  • Trauma

ASJC Scopus subject areas

  • Surgery

Cite this

De Moya, M. A., Seaver, C., Spaniolas, K., Inaba, K., Nguyen, M., Veltman, Y., ... Pizano, L. (2007). Occult pneumothorax in trauma patients: Development of an objective scoring system. Journal of Trauma - Injury, Infection and Critical Care, 63(1), 13-17. https://doi.org/10.1097/TA.0b013e31806864fc

Occult pneumothorax in trauma patients : Development of an objective scoring system. / De Moya, Marc A.; Seaver, Christopher; Spaniolas, Konstantinos; Inaba, Kenji; Nguyen, Michael; Veltman, Yevgeniy; Shatz, David V; Alam, Hasan B.; Pizano, Louis.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 63, No. 1, 07.2007, p. 13-17.

Research output: Contribution to journalArticle

De Moya, MA, Seaver, C, Spaniolas, K, Inaba, K, Nguyen, M, Veltman, Y, Shatz, DV, Alam, HB & Pizano, L 2007, 'Occult pneumothorax in trauma patients: Development of an objective scoring system', Journal of Trauma - Injury, Infection and Critical Care, vol. 63, no. 1, pp. 13-17. https://doi.org/10.1097/TA.0b013e31806864fc
De Moya, Marc A. ; Seaver, Christopher ; Spaniolas, Konstantinos ; Inaba, Kenji ; Nguyen, Michael ; Veltman, Yevgeniy ; Shatz, David V ; Alam, Hasan B. ; Pizano, Louis. / Occult pneumothorax in trauma patients : Development of an objective scoring system. In: Journal of Trauma - Injury, Infection and Critical Care. 2007 ; Vol. 63, No. 1. pp. 13-17.
@article{d28c5be40b8045d3a2606bd1dd974239,
title = "Occult pneumothorax in trauma patients: Development of an objective scoring system",
abstract = "BACKGROUND: The incidence of occult pneumothorax (OPTX) has dramatically increased since the widespread use of computed tomography (CT) scanning. The OPTX is defined as a pneumothorax not identified on plain chest X-ray but detected by CT scan. The overall reported incidence is about 5{\%} to 8{\%} of all trauma patients. We conducted a 5-year review of our OPTX incidence and asked if an objective score could be developed to better quantify the OPTX. This in turn may guide the practitioner with the decision to observe these patients. METHODS: This is a retrospective review of all trauma patients in a Level I university trauma center during a 5-year period. The patients were identified by a query of all pneumothoraces in our trauma registry. Those X-ray results were then reviewed to identify those who had OPTX. After developing an OPTX score on a small number, we retrospectively scored 50 of the OPTXs by taking the largest perpendicular distance in millimeters from the chest wall of the largest air pocket. We then added 10 or 20 to this if the OPTX was either anterior/posterior or lateral, respectively. RESULTS: A total of 21,193 trauma patients were evaluated and 1,295 patients with pneumothoraces (6.1{\%}) were identified. Of the 1,295 patients with pneumothoraces, 379 (29.5{\%}) OPTXs were identified. The overall incidence of OPTX was 1.8{\%}: 95.7{\%} occurred after blunt trauma, 222 (59{\%}) of the OPTX patients had chest tubes and of the remaining 157 without chest tubes, 27 (17{\%}) were on positive pressure ventilation. Of the 50 studies selected for scoring, the average score was 28.5. The average score for those with chest tubes was 34. The average score for those without chest tubes was 21. The positive predictive value for need of chest tube if the score was >30 was 78{\%} and the negative predictive value if the score was <20 was 70{\%}. Area under the receiver operator characteristic curve was 0.72, which was significant with p < 0.007. CONCLUSIONS: The OPTX score could quantify the size of the OPTX allowing the practitioner to better define a {"}small{"} pneumothorax. The management of OPTX is not standardized and further study using a more objective classification may assist the surgeon's decision-making. The application of a scoring system may also decrease unnecessary insertion of chest tubes for small OPTXs and is currently being prospectively validated.",
keywords = "Occult pneumothorax, Pneumothorax, Pneumothorax scoring, Trauma",
author = "{De Moya}, {Marc A.} and Christopher Seaver and Konstantinos Spaniolas and Kenji Inaba and Michael Nguyen and Yevgeniy Veltman and Shatz, {David V} and Alam, {Hasan B.} and Louis Pizano",
year = "2007",
month = "7",
doi = "10.1097/TA.0b013e31806864fc",
language = "English (US)",
volume = "63",
pages = "13--17",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Occult pneumothorax in trauma patients

T2 - Development of an objective scoring system

AU - De Moya, Marc A.

AU - Seaver, Christopher

AU - Spaniolas, Konstantinos

AU - Inaba, Kenji

AU - Nguyen, Michael

AU - Veltman, Yevgeniy

AU - Shatz, David V

AU - Alam, Hasan B.

AU - Pizano, Louis

PY - 2007/7

Y1 - 2007/7

N2 - BACKGROUND: The incidence of occult pneumothorax (OPTX) has dramatically increased since the widespread use of computed tomography (CT) scanning. The OPTX is defined as a pneumothorax not identified on plain chest X-ray but detected by CT scan. The overall reported incidence is about 5% to 8% of all trauma patients. We conducted a 5-year review of our OPTX incidence and asked if an objective score could be developed to better quantify the OPTX. This in turn may guide the practitioner with the decision to observe these patients. METHODS: This is a retrospective review of all trauma patients in a Level I university trauma center during a 5-year period. The patients were identified by a query of all pneumothoraces in our trauma registry. Those X-ray results were then reviewed to identify those who had OPTX. After developing an OPTX score on a small number, we retrospectively scored 50 of the OPTXs by taking the largest perpendicular distance in millimeters from the chest wall of the largest air pocket. We then added 10 or 20 to this if the OPTX was either anterior/posterior or lateral, respectively. RESULTS: A total of 21,193 trauma patients were evaluated and 1,295 patients with pneumothoraces (6.1%) were identified. Of the 1,295 patients with pneumothoraces, 379 (29.5%) OPTXs were identified. The overall incidence of OPTX was 1.8%: 95.7% occurred after blunt trauma, 222 (59%) of the OPTX patients had chest tubes and of the remaining 157 without chest tubes, 27 (17%) were on positive pressure ventilation. Of the 50 studies selected for scoring, the average score was 28.5. The average score for those with chest tubes was 34. The average score for those without chest tubes was 21. The positive predictive value for need of chest tube if the score was >30 was 78% and the negative predictive value if the score was <20 was 70%. Area under the receiver operator characteristic curve was 0.72, which was significant with p < 0.007. CONCLUSIONS: The OPTX score could quantify the size of the OPTX allowing the practitioner to better define a "small" pneumothorax. The management of OPTX is not standardized and further study using a more objective classification may assist the surgeon's decision-making. The application of a scoring system may also decrease unnecessary insertion of chest tubes for small OPTXs and is currently being prospectively validated.

AB - BACKGROUND: The incidence of occult pneumothorax (OPTX) has dramatically increased since the widespread use of computed tomography (CT) scanning. The OPTX is defined as a pneumothorax not identified on plain chest X-ray but detected by CT scan. The overall reported incidence is about 5% to 8% of all trauma patients. We conducted a 5-year review of our OPTX incidence and asked if an objective score could be developed to better quantify the OPTX. This in turn may guide the practitioner with the decision to observe these patients. METHODS: This is a retrospective review of all trauma patients in a Level I university trauma center during a 5-year period. The patients were identified by a query of all pneumothoraces in our trauma registry. Those X-ray results were then reviewed to identify those who had OPTX. After developing an OPTX score on a small number, we retrospectively scored 50 of the OPTXs by taking the largest perpendicular distance in millimeters from the chest wall of the largest air pocket. We then added 10 or 20 to this if the OPTX was either anterior/posterior or lateral, respectively. RESULTS: A total of 21,193 trauma patients were evaluated and 1,295 patients with pneumothoraces (6.1%) were identified. Of the 1,295 patients with pneumothoraces, 379 (29.5%) OPTXs were identified. The overall incidence of OPTX was 1.8%: 95.7% occurred after blunt trauma, 222 (59%) of the OPTX patients had chest tubes and of the remaining 157 without chest tubes, 27 (17%) were on positive pressure ventilation. Of the 50 studies selected for scoring, the average score was 28.5. The average score for those with chest tubes was 34. The average score for those without chest tubes was 21. The positive predictive value for need of chest tube if the score was >30 was 78% and the negative predictive value if the score was <20 was 70%. Area under the receiver operator characteristic curve was 0.72, which was significant with p < 0.007. CONCLUSIONS: The OPTX score could quantify the size of the OPTX allowing the practitioner to better define a "small" pneumothorax. The management of OPTX is not standardized and further study using a more objective classification may assist the surgeon's decision-making. The application of a scoring system may also decrease unnecessary insertion of chest tubes for small OPTXs and is currently being prospectively validated.

KW - Occult pneumothorax

KW - Pneumothorax

KW - Pneumothorax scoring

KW - Trauma

UR - http://www.scopus.com/inward/record.url?scp=34447333954&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34447333954&partnerID=8YFLogxK

U2 - 10.1097/TA.0b013e31806864fc

DO - 10.1097/TA.0b013e31806864fc

M3 - Article

VL - 63

SP - 13

EP - 17

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 1

ER -