Prevalence of large and occult pneumothoraces in patients with severe blunt trauma upon hospital admission: experience of 526 cases in a French level 1 trauma center
Abstract Background Occult pneumothoraces (PTXs), which are not visible on chest x-ray, may progress to tension PTX. The aim of study was to establish the prevalence of large occult PTXs upon admission of patients with severe blunt trauma, according to prehospital mechanical ventilation. Methods Pat...
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| Veröffentlicht in: | The American journal of emergency medicine 2015-06, Vol.33 (6), p.796-801 |
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| creator | Charbit, Jonathan, MD Millet, Ingrid, MD Maury, Camille, MD Conte, Benjamin, MD Roustan, Jean-Paul, MD Taourel, Patrice, MD, PhD Capdevila, Xavier, MD, PhD |
| description | Abstract Background Occult pneumothoraces (PTXs), which are not visible on chest x-ray, may progress to tension PTX. The aim of study was to establish the prevalence of large occult PTXs upon admission of patients with severe blunt trauma, according to prehospital mechanical ventilation. Methods Patients with severe trauma consecutively admitted to our institution for 5 years were retrospectively analyzed. All patients with blunt thoracic trauma who had undergone computed tomographic (CT) within the first hour of hospitalization were included. Mechanical ventilation was considered as early if it was introduced in the prehospital period or on arrival at the hospital. Occult PTXs were defined as PTXs not visible on chest x-ray. All PTXs were measured on CT scan (largest thickness and vertical dimension). Large occult PTXs were defined by a largest thickness of 30 mm or more. Results Of the 526 patients studied, 395 (75%) were male, mean age was 37.9 years, mean Injury Severity Score was 22.2, and 247 (47%) received early mechanical ventilation. Of 429 diagnosed PTXs, 296 (69%) were occult. The proportion of occult PTXs classified as large was 11% (95% confidence interval, 8%-15%). The overall prevalence of large occult PTXs was 6% (95% confidence interval, 4%-8%). Both CT measurements and proportion of large occult PTXs were found statistically comparable in patients with or without mechanical ventilation. Conclusions Six percent of studied patients with severe trauma had a large and occult PTX as soon as admission despite a normal chest x-ray result. The observed sizes and rates of occult PTX were comparable regardless of the initiation of early mechanical ventilation. |
| doi_str_mv | 10.1016/j.ajem.2015.03.057 |
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The aim of study was to establish the prevalence of large occult PTXs upon admission of patients with severe blunt trauma, according to prehospital mechanical ventilation. Methods Patients with severe trauma consecutively admitted to our institution for 5 years were retrospectively analyzed. All patients with blunt thoracic trauma who had undergone computed tomographic (CT) within the first hour of hospitalization were included. Mechanical ventilation was considered as early if it was introduced in the prehospital period or on arrival at the hospital. Occult PTXs were defined as PTXs not visible on chest x-ray. All PTXs were measured on CT scan (largest thickness and vertical dimension). Large occult PTXs were defined by a largest thickness of 30 mm or more. Results Of the 526 patients studied, 395 (75%) were male, mean age was 37.9 years, mean Injury Severity Score was 22.2, and 247 (47%) received early mechanical ventilation. Of 429 diagnosed PTXs, 296 (69%) were occult. The proportion of occult PTXs classified as large was 11% (95% confidence interval, 8%-15%). The overall prevalence of large occult PTXs was 6% (95% confidence interval, 4%-8%). Both CT measurements and proportion of large occult PTXs were found statistically comparable in patients with or without mechanical ventilation. Conclusions Six percent of studied patients with severe trauma had a large and occult PTX as soon as admission despite a normal chest x-ray result. The observed sizes and rates of occult PTX were comparable regardless of the initiation of early mechanical ventilation.</description><identifier>ISSN: 0735-6757</identifier><identifier>EISSN: 1532-8171</identifier><identifier>DOI: 10.1016/j.ajem.2015.03.057</identifier><identifier>PMID: 25881742</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Blood pressure ; Computed tomography ; Emergency ; Emergency medical care ; Female ; France - epidemiology ; Human health and pathology ; Humans ; Injuries ; Injury Severity Score ; Life Sciences ; Male ; Medical imaging ; Occult sciences ; Pneumothorax - diagnostic imaging ; Pneumothorax - epidemiology ; Prevalence ; Pulmonology and respiratory tract ; Respiration, Artificial ; Retrospective Studies ; Thoracic Injuries - diagnostic imaging ; Thoracic Injuries - epidemiology ; Tomography, X-Ray Computed ; Trauma Centers ; Ventilation ; Wounds, Nonpenetrating - diagnostic imaging ; Wounds, Nonpenetrating - epidemiology</subject><ispartof>The American journal of emergency medicine, 2015-06, Vol.33 (6), p.796-801</ispartof><rights>2015</rights><rights>Copyright © 2015. Published by Elsevier Inc.</rights><rights>Copyright Elsevier Limited 2015</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c543t-b81b05ce82ca186d267d446ac84be96dc79a3481c59f16971a3d5a95dd1c014e3</citedby><cites>FETCH-LOGICAL-c543t-b81b05ce82ca186d267d446ac84be96dc79a3481c59f16971a3d5a95dd1c014e3</cites><orcidid>0000-0001-8583-3930 ; 0000-0002-6332-5131 ; 0000-0001-6465-1919 ; 0000-0002-9791-8779</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0735675715002314$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25881742$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.umontpellier.fr/hal-02007255$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Charbit, Jonathan, MD</creatorcontrib><creatorcontrib>Millet, Ingrid, MD</creatorcontrib><creatorcontrib>Maury, Camille, MD</creatorcontrib><creatorcontrib>Conte, Benjamin, MD</creatorcontrib><creatorcontrib>Roustan, Jean-Paul, MD</creatorcontrib><creatorcontrib>Taourel, Patrice, MD, PhD</creatorcontrib><creatorcontrib>Capdevila, Xavier, MD, PhD</creatorcontrib><title>Prevalence of large and occult pneumothoraces in patients with severe blunt trauma upon hospital admission: experience of 526 cases in a French level 1 trauma center</title><title>The American journal of emergency medicine</title><addtitle>Am J Emerg Med</addtitle><description>Abstract Background Occult pneumothoraces (PTXs), which are not visible on chest x-ray, may progress to tension PTX. The aim of study was to establish the prevalence of large occult PTXs upon admission of patients with severe blunt trauma, according to prehospital mechanical ventilation. Methods Patients with severe trauma consecutively admitted to our institution for 5 years were retrospectively analyzed. All patients with blunt thoracic trauma who had undergone computed tomographic (CT) within the first hour of hospitalization were included. Mechanical ventilation was considered as early if it was introduced in the prehospital period or on arrival at the hospital. Occult PTXs were defined as PTXs not visible on chest x-ray. All PTXs were measured on CT scan (largest thickness and vertical dimension). Large occult PTXs were defined by a largest thickness of 30 mm or more. Results Of the 526 patients studied, 395 (75%) were male, mean age was 37.9 years, mean Injury Severity Score was 22.2, and 247 (47%) received early mechanical ventilation. Of 429 diagnosed PTXs, 296 (69%) were occult. The proportion of occult PTXs classified as large was 11% (95% confidence interval, 8%-15%). The overall prevalence of large occult PTXs was 6% (95% confidence interval, 4%-8%). Both CT measurements and proportion of large occult PTXs were found statistically comparable in patients with or without mechanical ventilation. Conclusions Six percent of studied patients with severe trauma had a large and occult PTX as soon as admission despite a normal chest x-ray result. The observed sizes and rates of occult PTX were comparable regardless of the initiation of early mechanical ventilation.</description><subject>Adult</subject><subject>Blood pressure</subject><subject>Computed tomography</subject><subject>Emergency</subject><subject>Emergency medical care</subject><subject>Female</subject><subject>France - epidemiology</subject><subject>Human health and pathology</subject><subject>Humans</subject><subject>Injuries</subject><subject>Injury Severity Score</subject><subject>Life Sciences</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Occult sciences</subject><subject>Pneumothorax - diagnostic imaging</subject><subject>Pneumothorax - epidemiology</subject><subject>Prevalence</subject><subject>Pulmonology and respiratory tract</subject><subject>Respiration, Artificial</subject><subject>Retrospective Studies</subject><subject>Thoracic Injuries - diagnostic imaging</subject><subject>Thoracic Injuries - epidemiology</subject><subject>Tomography, X-Ray Computed</subject><subject>Trauma Centers</subject><subject>Ventilation</subject><subject>Wounds, Nonpenetrating - 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epidemiology</topic><topic>Human health and pathology</topic><topic>Humans</topic><topic>Injuries</topic><topic>Injury Severity Score</topic><topic>Life Sciences</topic><topic>Male</topic><topic>Medical imaging</topic><topic>Occult sciences</topic><topic>Pneumothorax - diagnostic imaging</topic><topic>Pneumothorax - epidemiology</topic><topic>Prevalence</topic><topic>Pulmonology and respiratory tract</topic><topic>Respiration, Artificial</topic><topic>Retrospective Studies</topic><topic>Thoracic Injuries - diagnostic imaging</topic><topic>Thoracic Injuries - epidemiology</topic><topic>Tomography, X-Ray Computed</topic><topic>Trauma Centers</topic><topic>Ventilation</topic><topic>Wounds, Nonpenetrating - diagnostic imaging</topic><topic>Wounds, Nonpenetrating - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Charbit, Jonathan, MD</creatorcontrib><creatorcontrib>Millet, Ingrid, MD</creatorcontrib><creatorcontrib>Maury, Camille, MD</creatorcontrib><creatorcontrib>Conte, Benjamin, MD</creatorcontrib><creatorcontrib>Roustan, Jean-Paul, MD</creatorcontrib><creatorcontrib>Taourel, Patrice, MD, PhD</creatorcontrib><creatorcontrib>Capdevila, Xavier, MD, PhD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><jtitle>The American journal of emergency medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Charbit, Jonathan, MD</au><au>Millet, Ingrid, MD</au><au>Maury, Camille, MD</au><au>Conte, Benjamin, MD</au><au>Roustan, Jean-Paul, MD</au><au>Taourel, Patrice, MD, PhD</au><au>Capdevila, Xavier, MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prevalence of large and occult pneumothoraces in patients with severe blunt trauma upon hospital admission: experience of 526 cases in a French level 1 trauma center</atitle><jtitle>The American journal of emergency medicine</jtitle><addtitle>Am J Emerg Med</addtitle><date>2015-06-01</date><risdate>2015</risdate><volume>33</volume><issue>6</issue><spage>796</spage><epage>801</epage><pages>796-801</pages><issn>0735-6757</issn><eissn>1532-8171</eissn><abstract>Abstract Background Occult pneumothoraces (PTXs), which are not visible on chest x-ray, may progress to tension PTX. The aim of study was to establish the prevalence of large occult PTXs upon admission of patients with severe blunt trauma, according to prehospital mechanical ventilation. Methods Patients with severe trauma consecutively admitted to our institution for 5 years were retrospectively analyzed. All patients with blunt thoracic trauma who had undergone computed tomographic (CT) within the first hour of hospitalization were included. Mechanical ventilation was considered as early if it was introduced in the prehospital period or on arrival at the hospital. Occult PTXs were defined as PTXs not visible on chest x-ray. All PTXs were measured on CT scan (largest thickness and vertical dimension). Large occult PTXs were defined by a largest thickness of 30 mm or more. Results Of the 526 patients studied, 395 (75%) were male, mean age was 37.9 years, mean Injury Severity Score was 22.2, and 247 (47%) received early mechanical ventilation. Of 429 diagnosed PTXs, 296 (69%) were occult. The proportion of occult PTXs classified as large was 11% (95% confidence interval, 8%-15%). The overall prevalence of large occult PTXs was 6% (95% confidence interval, 4%-8%). Both CT measurements and proportion of large occult PTXs were found statistically comparable in patients with or without mechanical ventilation. Conclusions Six percent of studied patients with severe trauma had a large and occult PTX as soon as admission despite a normal chest x-ray result. The observed sizes and rates of occult PTX were comparable regardless of the initiation of early mechanical ventilation.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>25881742</pmid><doi>10.1016/j.ajem.2015.03.057</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0001-8583-3930</orcidid><orcidid>https://orcid.org/0000-0002-6332-5131</orcidid><orcidid>https://orcid.org/0000-0001-6465-1919</orcidid><orcidid>https://orcid.org/0000-0002-9791-8779</orcidid></addata></record> |
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| subjects | Adult Blood pressure Computed tomography Emergency Emergency medical care Female France - epidemiology Human health and pathology Humans Injuries Injury Severity Score Life Sciences Male Medical imaging Occult sciences Pneumothorax - diagnostic imaging Pneumothorax - epidemiology Prevalence Pulmonology and respiratory tract Respiration, Artificial Retrospective Studies Thoracic Injuries - diagnostic imaging Thoracic Injuries - epidemiology Tomography, X-Ray Computed Trauma Centers Ventilation Wounds, Nonpenetrating - diagnostic imaging Wounds, Nonpenetrating - epidemiology |
| title | Prevalence of large and occult pneumothoraces in patients with severe blunt trauma upon hospital admission: experience of 526 cases in a French level 1 trauma center |
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