Management of hemodynamically stable penetrating chest trauma without cardiac injury in Marseille

Abstract Background Penetrating chest trauma (PCT) is uncommon in Western Europe but carries substantial morbidity. Non-operative treatment (NOT) is widely practiced in regions with high rates of penetrating injuries, whereas European centers continue to report higher surgical exploration rates. In Marseille, a recent increase in penetrating trauma—combined with reduced resources during the global health crisis—prompted a reassessment of management strategies. This study evaluated changes in practice and the effectiveness of NOT for hemodynamically stable PCT sparing the cardiac box. Methods We conducted a retrospective multicentric study including all hemodynamically stable patients with PCT excluding the cardiac box admitted to Marseille University Hospitals from 2015 to 2024. Patients were divided into an Early Period Group (EPG; before June 1, 2020) and a Recent Period Group (RPG; on or after June 1, 2020). The primary outcome was the rate of NOT; secondary outcomes included a comparison between periods and multivariate identification of predictors of NOT success. Results Among 268 included patients (EPG n = 129; RPG n = 139), stab wounds predominated (86%). Initial NOT was performed in 78% of cases, and was more frequently attempted in RPG (74% vs. 81%, p = 0.17). Thoracic surgery decreased non-significantly in the RPG (34% vs. 25%, p = 0.11). NOT failure was low and similar (8.5% vs. 6.5%, p = 0.52). Hospital length of stay decreased in the RPG (7.6 vs. 5.2 days, p < 0.04), with no increase in 3-month mortality ( n = 1, 0.78% vs. n = 0, 0%; p = 0.48). Independent predictors of NOT success were presentation during reduced-service hours (OR 4.78) and isolated pneumothorax on initial imaging (OR 7.40). Conclusions NOT was the predominant initial strategy and appeared feasible in selected penetrating chest trauma without cardiac injury - particularly isolated pneumothorax - with low failure rates, provided close monitoring and rapid surgical availability.