Trauma-Associated Pneumothorax: A Comparative Outcome Study Of Observational Management And Tube Thoracotomy

Background: Traumatic pneumothorax is a common consequence of thoracic trauma and can lead to significant morbidity. While tube thoracostomy has traditionally been the standard treatment, observational management is increasingly being considered for select patients. Objective: To compare the clinical outcomes of observational management versus tube thoracostomy in adult patients with traumatic pneumothorax. Methodology: A retrospective cohort study was conducted at Al-Noor Specialist Hospital, Makkah, Saudi Arabia, from January to December 2024. A total of 70 patients diagnosed with traumatic pneumothorax were included and divided into two groups: observational (n=35) and tube thoracostomy (n=35). Baseline characteristics, treatment success, complications, hospital stay, pain scores, and recurrence rates were analyzed using SPSS v27. Multivariable logistic regression was used to assess predictors of treatment success. Results: Treatment success was significantly higher in the observational group (88.6% vs. 68.6%, p=0.046). The observational group had fewer complications (5.7% vs. 28.6%, p=0.016), shorter hospital stays (2.4 ± 1.1 vs. 5.1 ± 2.3 days, p<0.001), and lower pain scores (2.3 ± 0.9 vs. 5.7 ± 1.4, p<0.001). Recurrence rates were similar between groups (p=0.62). After adjusting for confounding variables, observational management remained independently associated with improved outcomes (OR = 3.2; 95% CI: 1.1–9.4; p=0.035). Conclusion: Observational management is a safe and effective alternative to tube thoracostomy for selected patients with traumatic pneumothorax, offering better clinical outcomes and reduced morbidity.