Table 1 Conservative management of traumatic pneumothorax

Hegarty MM 1976 [20]

Prospective case series

131 patients with traumatic chest injuries. 58 with pneumothorax <1.5 cm or hemothorax below 9th rib managed without TT initially

8 of 58 later required TT. No in-hospital deaths in the group initially managed without TT

Pneumothoraces and hemothoraces not separated in conservative group

Knottenbelt and vander Spuy 1990 [21]

Prospective observational case series

803 adult patients with traumatic pneumathoraces, observation occurred in 333 with pneumothorax size <1.5 cm

Need for thoracostomy drainage. 33/333 (10%) required subsequent drainage

Definition of failure of conservative therapy no specifically defined. Long-term outcomes weren’t evaluated

Bridges KG et al. 1993 [22]

Retrospective case series

90 patients with traumatic pneumothorax. 35 patients were identified as having an occult pneumothorax noted on CT

10 of the 35 ‘occult pneumothorax’ got immediate TT due to need for ventilation. 20% (5) of the remaining pts required delayed TT

Retrospective, no clarification on reason to intubate on the 5 patients who were initially observed. No documentation of follow-up or complication rates

Johnson G 1996 [23]

Retrospective case series

54 adult patients, observation management in 29

Need for thoracostomy drainage. 2/29 (6%)

Small N, no specification of pneumothorax classification

Dural K et al. 2005 [24]

Prospective observational trial

108 patients with pneumothoraces classified as 20%, 10% or less than 10% initially treated with conservative management

46 patients (43%) required TT due to enlarging pneumothorax. A larger initial pneumothorax was associated with increased need for TT

Single study

Barrios C et al. 2008 [25]

Retrospective trauma registry review

59 occult pneumothoraces, 51 had conservative management, including 16 of 20 who received PPV had conservative management

Occult pneumothoraces receiving TT had higher Revised Trauma Score, higher ICU and hospital LOS

Retrospective, with no protocol defined for conservative management