Occult tension pneumothorax discovered following imaging for adult trauma patients in the modern major trauma system: a multicentre observational study.

Autor:	Naumann DN; Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK david.naumann@nhs.net.; Department of Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK., Sellon E; Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK., Mitchinson S; Emergency Department, Barts Health NHS Trust, London, UK., Tucker H; Emergency Department, St George's Healthcare NHS Trust, London, UK., Marsden MER; Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK.; Emergency Department, Barts Health NHS Trust, London, UK., Norris-Cervetto E; Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK., Bafitis V; Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK., Smith T; Department of Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK., Bradley R; Emergency Department, Barts Health NHS Trust, London, UK., Alzarrad A; Emergency Department, Barts Health NHS Trust, London, UK., Naeem S; Emergency Department, Barts Health NHS Trust, London, UK., Smith G; Emergency Department, Barts Health NHS Trust, London, UK., Dillane S; Emergency Department, St George's Healthcare NHS Trust, London, UK., Humphrys-Eveleigh A; Emergency Department, St George's Healthcare NHS Trust, London, UK., Wordsworth M; Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK.; Department of Surgery, Imperial College Healthcare NHS Trust, London, UK., Sanchez-Thompson N; Department of Surgery, Imperial College Healthcare NHS Trust, London, UK., Bootland D; Emergency Department, Brighton and Sussex University Hospitals NHS Trust, Worthing, UK., Brown L; Emergency Department, Brighton and Sussex University Hospitals NHS Trust, Worthing, UK.
Jazyk:	angličtina
Zdroj:	BMJ military health [BMJ Mil Health] 2024 Mar 20; Vol. 170 (2), pp. 123-129. Date of Electronic Publication: 2024 Mar 20.
DOI:	10.1136/bmjmilitary-2022-002126
Abstrakt:	Background: Tension pneumothorax following trauma is a life-threatening emergency and radiological investigation is normally discouraged prior to treatment in traditional trauma doctrines such as ATLS. Some trauma patients may be physiologically stable enough for diagnostic imaging and occult tension pneumothorax is discovered radiologically. We assessed the outcomes of these patients and compared them with those with clinical diagnosis of tension pneumothorax prior to imaging. Methods: A multicentre civilian-military collaborative network of six major trauma centres in the UK collected observational data from adult patients who had a diagnosis of traumatic tension pneumothorax during a 33-month period. Patients were divided into 'radiological' (diagnosis following CT/CXR) or 'clinical' (no prior CT/CXR) groups. The effect of radiological diagnosis on survival was analysed using multivariable logistic regression that included the covariates of age, gender, comorbidities and Injury Severity Score. Results: There were 133 patients, with a median age of 41 (IQR 24-61); 108 (81%) were male. Survivors included 49 of 59 (83%) in the radiological group and 59 of 74 (80%) in the clinical group (p=0.487). Multivariable logistic regression showed no significant association between radiological diagnosis and survival (OR 2.40, 95% CI 0.80 to 7.95; p=0.130). There was no significant difference in mortality between the groups. Conclusion: Radiological imaging may be appropriate for selected trauma patients at risk of tension pneumothorax if they are considered haemodynamically stable. Trauma patients may be physiologically stable enough for radiological imaging but have occult tension pneumothorax because they did not have the typical clinical presentation. The historical dogma of the 'forbidden scan' no longer applies to such patients. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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