Efficacy of follow-up evaluation in penetrating thoracic injuries: 3-vs. 6-hour radiographs of the chest

Pneumothorax (PTX) in patients with penetrating thoracic trauma is routinel y ruled out with serial chest radiographs (CXRs), This study examined the e fficacy of a shortened time period between initial and follow-up radiograph s. Patients with penetrating torso injuries treated at a Level-1 trauma cen ter received a CXR during their initial evaluation. If no pneumothorax or h emothorax was noted, and the patient did not require immediate admission to the Intensive Care Unit or operating room, a repeat chest film was taken a t 3 and 6 h, Findings were treated as clinically indicated, and patients we re discharged home if the last radiograph revealed no evidence of pathology . Over a 15-month period, 116 patients were evaluated for penetrating thora cic injuries (93 stabbings, 23 gunshot wounds) and had no pneumothorax dete cted on initial CXR, Two patients had pneumothorax detectable only by compu ted tomography, One patient had a normal initial CXR, but developed a PTX o n the 3-h film, requiring tube thoracostomy, No patients developed a PTX on the 6-h study that was not present on the initial or 3-h CXR, In conclusio n, extending the time between initial and final CXRs to 6 h in patients wit h penetrating thoracic trauma provided no additional information that was n ot available on the 3-h film. (C) 2001 Elsevier Science Inc.