Prospective Evaluation of Safe Observation Period after Asymptomatic Penetrating Thoracic Injury: 1 Hour is Enough

  • Farhad Heydari Department of Emergency Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran http://orcid.org/0000-0002-6296-0045
  • Babak Masoumi Department of Emergency Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran http://orcid.org/0000-0002-5928-1770
  • Majid Zamani Department of Emergency Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran http://orcid.org/0000-0002-6409-2931
  • Mohammad Nasr-Esfahani Department of Emergency Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran http://orcid.org/0000-0002-2716-5038
Keywords: Delayed Pneumothorax, Hemothorax, Penetrating, Pneumothorax, Thoracic Injury

Abstract

Introduction: The observation period was recently challenged by some studies; and it has been suggested that a 1-hour observation period may be sufficient to allow safe discharge in asymptomatic patients with penetrating thoracic injury (PTI) and normal initial Chest X-Ray (CXR). Objective: The current study was performed to investigate if in asymptomatic and hemodynamically stable patients with PTIs who has an initial normal evaluation, 1-hour observation interval is safe to detect clinically significant injuries and is it possible to discharge these patients safely after a negative Extended – Focused Assessment with Sonography in Trauma (E-FAST) at hour1 instead of hour 3. Method: This cross-sectional study was performed on asymptomatic patients with penetrating thoracic injury, referred to emergency department (ED) and normal initial CXR and the Extended Focused Assessment with Sonography in Trauma (E-FAST). The second E-FAST was done 1 hour after the first one and the third repeat E-FAST and control CXR then performed 3 hours post-injury. 24 hours follow up by phone call was done for each patient after discharge. Results: Finally, 117 patients with the average ages of 25.9 ± 7.8 years were enrolled of whom 92.5% were male. Eight patients developed PTX or HTX during first hour of observation that were diagnosed by E-FAST or CT scan requested by the in-charge physician. One hundred-nine patient completed E-FAST and radiograph studies at times zero, 1 h, and 3 h. One patient had a normal initial evaluation but demonstrated a PTX on the 3-h managed without intervention. The rate of delayed abnormality after an initially normal study was 7.7 % (9/117). No discharged patients returned to our ED with delayed manifestations of either PTX or HTX. Conclusion: The results of our study have shown that asymptomatic patients with PTI with negative initial evaluation and no deterioration at intervals, about 1 hour may be sufficient for detection of clinically significant pathology, considered for safe and early discharge.

Downloads

Download data is not yet available.

References

1. American College of Surgeons. Advanced trauma life support for doctors, student course manual. 10th ed ed. Chicago, IL: ACS;2018.
2. Kulshrestha P, Munshi I, Wait R. Profile of chest trauma in a level I trauma center. J Trauma. 2004;57(3):576-81.
3. Wright FL, Esposito TJ. Penetrating trauma of the chest. Trauma Surgery: Springer; 2014. p. 275-94.
4. Shatz DV, de la Pedraja J, Erbella J, Hameed M, Vail SJ. Efficacy of follow-up evaluation in penetrating thoracic injuries: 3- vs. 6-hour radiographs of the chest. J Emerg Med. 2001;20(3):281-4.
5. Seamon MJ, Medina CR, Pieri PG, Fisher CA, Gaughan JP, Bradley KM, et al. Follow-up after asymptomatic penetrating thoracic injury: 3 hours is enough. J Trauma. 2008;65(3):549-53.
6. Facundo GH, Martinez SI, Carvajal C. Treatment of Stable Patients with Penetrating Chest Trauma Caused by Stab Wounds: Three vs six Hours Follow-up. Panamerican J Trauma Crit Care Emerg Surg. 2013;2(3):101-5.
7. Mollberg NM, Wise SR, De Hoyos AL, Lin FJ, Merlotti G, Massad MG. Chest computed tomography for penetrating thoracic trauma after normal screening chest roentgenogram. Ann Thorac Surg. 2012;93(6):1830-5.
8. Henneman PL, Nathanson BH, Li H, Smithline HA, Blank FS, Santoro JP, et al. Emergency department patients who stay more than 6 hours contribute to crowding. J Emerg Med. 2010;39(1):105-12.
9. Seidzadeh Gooklan L, Yari A, Mayel M, Nazemi S, Movahedi M, Mirafzal A. Observation period for asymptomatic penetrating chest trauma: 1 or 3 h? Eur J Trauma Emerg Surg. 2018;44(6):829-33.
10. Berg RJ, Inaba K, Recinos G, Barmparas G, Teixeira PG, Georgiou C, et al. Prospective evaluation of early follow-up chest radiography after penetrating thoracic injury. World J Surg. 2013;37(6):1286-90.
Published
2019-06-22
How to Cite
Heydari, F., Masoumi, B., Zamani, M., & Nasr-Esfahani, M. (2019). Prospective Evaluation of Safe Observation Period after Asymptomatic Penetrating Thoracic Injury: 1 Hour is Enough. Advanced Journal of Emergency Medicine, 3(4), e39. https://doi.org/10.22114/ajem.v0i0.148
Section
Original article