Either Hypotension or Clinical Signs Alone Is a Reliable Indication for Immediate Tube Thoracostomy in Penetrating Chest Injury

We tried to study the relationship between hypotension, clinical findings and hemopneumothorax in penetrating chest injury to determine whether hypotension or clinical findings alone in penetrating chest injury is a reliable indicator for immediate tube thoracostomy. All patients(n=310) with penetrating chest injury admitted to a level I university affiliated trauma center over a two-year period were evaluated. Systolic blood pressure, clinical findings on primary survey and chest x-ray for the presence of hemothorax, pneumothorax or hemopneumothorax were compared. The statistical differences were determined by the Student’s t-test. Of 310 patients, 49 patients died in the trauma bay without chest x-ray, leaving 261 patients. A total of 155 patients (59.4%) had a lesion of hemothorax, peneumothorax, or hemopeumothorax an chest x-ray treated with tube thoracostomy. Hypotension was present in 41 patients (15.75) and hemothorax, pneumothorax, and hemopneumothorax was present in 38 of these 41(92.7%). Hypotension was associated with longer hospital stay, higher mortality an higher Injury Severity Score. Auscultation to detect hemothorax, pneumothorax or hemopneumothorax had a sensitivity of 62.6%, a specificity of 98.1%, an accuracy of 77.0%, and a positive predictive value of 98.0%. Penetrating chest injury with hypotension or decreased breathing sounds alone has a significant incidence of hemothorax, pneumothorax, or hemopneumothorax on the side of the injured hemothorax. We conclude that immediate tube thoracostomy before chest x-ray is warranted.(Tzu Chi Med J 1996; 8: 263-269)