Prospective study of the yield of physical examination compared with chest radiography in penetrating thoracic trauma

• Published in: Thorax 1990-08, Vol.45 (8), p.616-619
• Main Authors: Thomson, S R, Huizinga, W K, Hirshberg, A
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Biological and medical sciences; Female; Humans; Injuries of the thorax. Foreign bodies. Diseases due to physical agents; Male; Medical sciences; Middle Aged; Physical Examination; Prospective Studies; Radiography, Thoracic; Thoracic Injuries - diagnosis; Traumas. Diseases due to physical agents; Wounds, Gunshot - diagnosis; Wounds, Stab - diagnosis
• ISSN: 0040-6376; 1468-3296
• DOI: 10.1136/thx.45.8.616

A prospective study was conducted on 102 patients (84 male), with a median age of 27 years, who had sustained a penetrating chest wound to evaluate the ability of physical examination in comparison with chest radiography to determine management of these injuries. Knife wounds accounted for 92% of the injuries. Fifty three patients had a small collection of air or fluid in their pleural cavity that was not drained. Fifty six hemithoraces had a large collection of fluid or air and were treated by tube thoracostomy. Physical examination at presentation detected large collections of air and fluid correctly and predicted appropriate management (sensitivity 96%, specificity 94%). Residual collections of air or fluid or both were also predicted correctly by clinical examination. Seven small collections increased in size and required intubation. Routine pre-extubation radiographs were found to be of little value in management and their routine use is not recommended. Four patients required late thoracotomy for decortication. By using a policy of selective intubation, frequent clinical reassessment, and chest radiography when relevant, experienced trauma surgeons can manage most penetrating pleural injuries with an acceptably low complication rate.