The selective conservative management of small traumatic pneumothoraces following stab injuries is safe: experience from a high-volume trauma service in South Africa

The selective conservative management of small pneumothoraces (PTXs) following stab injuries is controversial. We reviewed a cohort of patients managed conservatively in a high volume trauma service in South Africa.

A retrospective review over a 2-year period identified 125 asymptomatic patients with small PTXs measuring <2 cm on chest radiograph who were managed conservatively.

Of the 125 patients included in the study, 92 % were male (115/125), and the median age for all patients was 21 years (19–24). Ninety-seven per cent (121/125) of the weapons involved were knives, and 3 % (4/125) were screwdrivers. Sixty-one per cent of all injuries were on the left side. Eighty-two per cent (102/125) sustained a single stab, and 18 % (23/125) had multiple stabs. Thirty-nine per cent (49/125) had a PTX <0.5 cm (Group A), 26 % (32/125) were ≥0.5 to <1 cm (Group B), 19 % (24/125) were ≥1 to <1.5 cm (Group C) and 15 % (20/125) were ≥1.5 to <2 cm (Group D). Three per cent of all patients (4/125) eventually required ICDs (one in Group C, three in Group D). All four patients had ICDs in situ for 24 h. The remaining 97 % (121/125) were all managed successfully by active clinical observation alone. There were no subsequent readmissions, morbidity or mortality as a direct result of our conservative approach.

The selective conservative management of asymptomatic small PTXs from stab injuries is safe if undertaken in the appropriate setting.