Defining the optimal timing of interval chest radiograph in conservatively managed small pneumothorax from thoracic stab wounds – a South African experience

Background Selective conservative management of asymptomatic patients with small pneumothorax (PTX) in the specific setting of thoracic stab wounds (SWs) has been demonstrated to be safe. However, the optimal timing in obtaining interval chest radiograph (CXR) remains unknown. Methods A prospective study was conducted over a 14-year period on patients with isolated thoracic SWs who were asymptomatic with small PTX on CXR (<mpa#lt;&nbsp0.5 cm) that underwent active clinical observation at a major trauma centre in South Africa. Results Fifty patients were included (87% male, mean age: 24 years). 43 (86%) were male and the mean age was 27 years. All 50 were successfully managed without tube thoracostomy (TT), with no adverse outcome. 35 (70%) had their interval CXR obtained at 12 hours, 7 (14%) at 12–16 hours, 4 (8%) at 16–20 hours and 3 (6%) at 20–24 hours. All patients demonstrated complete resolution of PTX at each of the time intervals and remained asymptomatic. Conclusion In patients with asymptomatic small PTX < 0.5 cm, interval CXR at 12 hours invariably demonstrates complete resolution. As all patients remained asymptomatic, this may facilitate earlier patient discharge.