Conservative management of traumatic pneumothoraces: A retrospective cohort study

Objective Traumatic pneumothoraces (T‐PTXs) are traditionally managed with an intercostal catheter (ICC), despite little evidence for this. Success with conservative management of primary spontaneous PTX has been demonstrated, and our ED has adopted a conservative approach where safe for all PTX. Methods We reviewed all T‐PTXs at our institution over a 7‐year period to assess outcomes of those conservatively managed and compare with those who received an ICC. A total of 144 cases were identified, 65 managed conservatively and 79 invasively. Each was individually reviewed and variables including demographics, aetiology, smoking/lung disease history, T‐PTX size (apical interpleural distance and hemithorax percentage), length of stay, Revised Trauma Score, Injury Severity Score and delayed intervention/complications were recorded. Chi‐squared, Z‐score, Mann–Whitney U and t‐tests were used for analysis. Results The mean apical interpleural distance was 26.8 mm (95% confidence interval [CI] 22.1–29.7 mm) in the conservative group and 49.1 mm (95% CI 41.2–57.0 mm) in the ICC group (P