• Shahriar Zehtabchi, Eric J Morley, Dana Sajed, Oded Greenberg, and Richard Sinert.
• Department of Emergency Medicine, State University of New York, Downstate Medical Center/Kings County Hospital Center, United States. szehtabchi@yahoo.com
• Injury. 2009 Jan 1; 40 (1): 40-3.

BackgroundStab wounds to the thorax and upper abdomen have the potential to cause pneumothorax (PTX). When a CXR (CXR) obtained during initial resuscitation is negative, a second CXR (CXR-2) is commonly performed with the goal of identifying delayed PTX.ObjectivesTo assess the diagnostic yield of the CXR-2 in identifying delayed PTX.MethodsProspective observational study of patients (age >or=13 years) with stab wounds to the thorax (chest/back) and upper abdomen with suspected PTX, in a level 1 trauma centre. Patients were included if they had a negative initial CXR followed by a repeat CXR 3-6h after the initial one.Exclusion Criteriapatients who died, were transferred out of the ED, or received chest tubes before the second CXR. The outcome of interest was delayed PTX. All CXR were read by an attending radiologist. To test the inter-observer agreement, another blinded radiologist reviewed 20% of CXR. Continuous data is presented as mean+/-standard deviation and categorical data as percentages with 95% confidence interval (CI). Kappa statistics were used to measure the inter-observer agreement between radiologists.ResultsBetween January 2003 and December 2006 a total of 185 patients qualified for the enrollment (mean age: 28+/-10 years, age range: 13-65, 94% male). Only 2 patients (1.1%, 95% CI, 0.4- 4.1%) had PTX on the CXR-2. Both patients received chest tubes. The inter-observer agreement for radiology reports was high (kappa: 0.79).ConclusionOccurrence of delayed PTX in patients with stab wounds to the thorax and upper abdomen and negative triage CXR is rare.

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