ASYMPTOMATIC STAB WOUNDS OF THE CHEST

In a prospective study of 4106 consecutive cases of initially asymptom atic stab wounds of the chest, 88% were successfully treated as outpat ients after negative findings on a repeat chest x-ray film 6 hours aft er presentation, 12% of patients required tube thoracostomy for delaye d pneumothoraces of hemothoraces, 0.2% required thoracotomy for delaye d and continued bleeding or cardiac injuries, 1% of patients with smal l pneumothoraces (subjectively less than 20%) were observed, and 68% p atients remained asymptomatic. The accuracy of the initial chest x-ray film was 95% overall, with a specificity of 99.9%. The negative predi ctive value of only 87.4% precludes the immediate outpatient managemen t of these asymptomatic patients. The overall mortality was 0.1%, mort ality during or following surgery was 50%. Of the four patients with i nitially unsuspected cardiac injuries, two patients died in the operat ing room. Asymptomatic patients (with normal findings on chest x-ray f ilms) may be discharged after 8 hours of observation. Asymptomatic pat ients with nonprogressive small pneumothoraces (less than 20%) not req uiring a chest tube may be discharged after 48 hours of observation. T hirty-two percent of those observed for initially small pneumothoraces on chest x-ray films, had progression of their injuries and required tube thoracostomy. All patients should have close outpatient follow-up .