<< Emergency Department Evaluation And Management Of Blunt Chest And Lung Trauma (Trauma CME)


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Evidence-based medicine requires a critical appraisal of the literature based upon study methodology and number of subjects. Not all references are equally robust. The findings of a large, prospective, randomized, and blinded trial should carry more weight than a case report.

To help the reader judge the strength of each reference, pertinent information about the study is included in bold type following the reference, where available. In addition, the most informative references cited in this paper, as determined by the authors, are noted by an asterisk (*) next to the number of the reference.

  1. Kochanek KD, Murphy SL, Xu J, et al. Mortality in the United States, 2013. NCHS Data Brief. 2014(178):1-8. (National database review)

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  3. Galan G, Penalver JC, Paris F, et al. Blunt chest injuries in 1696 patients. Eur J Cardiothorac Surg. 1992;6(6):284-287. (Observational study; 1696 patients)

  4. Shorr RM, Crittenden M, Indeck M, et al. Blunt thoracic trauma. Analysis of 515 patients. Ann Surg. 1987;206(2):200- 205. (Retrospective study; 515 patients)

  5. Newman RJ, Jones IS. A prospective study of 413 consecutive car occupants with chest injuries. J Trauma. 1984;24(2):129- 135. (Prospective observational; 413 patients)

  6. Simon BJ, Cushman J, Barraco R, et al. Pain management guidelines for blunt thoracic trauma. J Trauma. 2005;59(5):1256-1267. (Guideline)

  7. Palvanen M, Kannus P, Niemi S, et al. Epidemiology of minimal trauma rib fractures in the elderly. Calcif Tissue Int. 1998;62(3):274-277. (Finland national database review)

  8. Barnea Y, Kashtan H, Skornick Y, et al. Isolated rib fractures in elderly patients: mortality and morbidity. Can J Surg. 2002;45(1):43-46. (Retrospective review; 77 patients)

  9. Clark GC, Schecter WP, Trunkey DD. Variables affecting outcome in blunt chest trauma: flail chest vs. pulmonary contusion. J Trauma. 1988;28(3):298-304. (Retrospective; 144 patients)

  10. Collins J. Chest wall trauma. J Thorac Imaging. 2000;15(2):112- 119. (Review)

  11. Sangster GP, Gonzalez-Beicos A, Carbo AI, et al. Blunt traumatic injuries of the lung parenchyma, pleura, thoracic wall, and intrathoracic airways: multidetector computer tomography imaging findings. Emerg Radiol. 2007;14(5):297-310. (Review)

  12. von Garrel T, Ince A, Junge A, et al. The sternal fracture: radiographic analysis of 200 fractures with special reference to concomitant injuries. J Trauma. 2004;57(4):837-844. (Retrospective; 200 patients)

  13. Mayberry JC. Imaging in thoracic trauma: the trauma surgeon’s perspective. J Thorac Imaging. 2000;15(2):76-86. (Review)

  14. Kang EY, Muller NL. CT in blunt chest trauma: pulmonary, tracheobronchial, and diaphragmatic injuries. Semin Ultrasound CT MR. 1996;17(2):114-118. (Review)

  15. Zinck SE, Primack SL. Radiographic and CT findings in blunt chest trauma. J Thorac Imaging. 2000;15(2):87-96. (Review)

  16. Farooq U, Raza W, Zia N, et al. Classification and management of chest trauma. J Coll Physicians Surg Pak. 2006;16(2):101-103. (Retrospective; 100 patients)

  17. Mirvis SE. Imaging of acute thoracic injury: the advent of MDCT screening. Semin Ultrasound CT MR. 2005;26(5):305- 331. (Review)

  18. Rees O, Mirvis SE, Shanmuganathan K. Multidetector-row CT of right hemidiaphragmatic rupture caused by blunt trauma: a review of 12 cases. Clin Radiol. 2005;60(12):1280- 1289. (Retrospective; 12 patients)

  19. Wintermark M, Schnyder P, Wicky S. Blunt traumatic rupture of a mainstem bronchus: spiral CT demonstration of the “fallen lung” sign. Eur Radiol. 2001;11(3):409-411. (Case report)

  20. Simon B, Ebert J, Bokhari F, et al. Management of pulmonary contusion and flail chest: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012;73(5 Suppl 4):S351-S361. (Guideline)

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  22. Hoth JJ, Stitzel JD, Gayzik FS, et al. The pathogenesis of pulmonary contusion: an open chest model in the rat. J Trauma. 2006;61(1):32-44. (Animal study)

  23. Raghavendran K, Notter RH, Davidson BA, et al. Lung contusion: inflammatory mechanisms and interaction with other injuries. Shock. 2009;32(2):122-130. (Review)

  24. Seitz DH, Perl M, Liener UC, et al. Inflammatory alterations in a novel combination model of blunt chest trauma and hemorrhagic shock. J Trauma. 2011;70(1):189-196. (Animal study)

  25. Knoferl MW, Liener UC, Seitz DH, et al. Cardiopulmonary, histological, and inflammatory alterations after lung contusion in a novel mouse model of blunt chest trauma. Shock. 2003;19(6):519-525. (Animal study)

  26. Leport T, Baudrit P, Potier P, et al. Study of rib fracture mechanisms based on the rib strain profiles in side and forward oblique impact. Stapp Car Crash J. 2011;55:199-250. (Post mortem autopsy study)

  27. Ziegler DW, Agarwal NN. The morbidity and mortality of rib fractures. J Trauma. 1994;37(6):975-979. (Retrospective; 711 patients)

  28. Sahn SA, Heffner JE. Spontaneous pneumothorax. N Engl J Med. 2000;342(12):868-874. (Review)

  29. Rotondo MF, Cribari C, Smith RS, Committee on Trauma, American College of Surgeons. Resources for the optimal care of the injured patient 2014. Available at: https://www.facs.org/quality%20programs/trauma/vrc/resources. Accessed October 30, 2015. (Committee on Trauma manual)

  30. Baker CC, Oppenheimer L, Stephens B, et al. Epidemiology of trauma deaths. Am J Surg. 1980;140(1):144-150. (Retrospective; 437 patients)

  31. Esposito TJ, Sanddal ND, Hansen JD, et al. Analysis of preventable trauma deaths and inappropriate trauma care in a rural state. J Trauma. 1995;39(5):955-962. (Retrospective)

  32. Esposito TJ, Sanddal TL, Reynolds SA, et al. Effect of a voluntary trauma system on preventable death and inappropriate care in a rural state. J Trauma. 2003;54(4):663-669. (Retrospective; 347 patients)

  33. Maio RF, Burney RE, Gregor MA, et al. A study of preventable trauma mortality in rural Michigan. J Trauma. 1996;41(1):83-90. (Retrospective; 155 patients)

  34. Sanddal TL, Esposito TJ, Whitney JR, et al. Analysis of preventable trauma deaths and opportunities for trauma care improvement in utah. J Trauma. 2011;70(4):970-977. (Retrospective;)

  35. Trunkey DD, Lim RC Jr, Blaisdell FW. Traumatic injury. A health care crisis. West J Med. 1974;120(1):92-94. (Communication)

  36. Hedges JR, Sacco WJ, Champion HR. An analysis of pre-hospital care of blunt trauma. J Trauma. 1982;22(12):989-993. (Retrospective)

  37. Stiell IG, Nesbitt LP, Pickett W, et al. The OPALS Major Trauma Study: impact of advanced life-support on survival and morbidity. CMAJ. 2008;178(9):1141-1152. (Prospective; 2867 patients)

  38. Pepe PE, Maio RF. Evolving challenges in prehospital trauma services. Current issues and suggested evaluation tools. Prehosp Disaster Med. 1993;8(1 Suppl):25-34. (Review)

  39. Pepe PE, Stewart RD, Copass MK. Prehospital management of trauma: a tale of three cities. Ann Emerg Med. 1986;15(12):1484-1490. (Prospective)

  40. Hedges JR, Feero S, Moore B, et al. Factors contributing to paramedic onscene time during evaluation and management of blunt trauma. Am J Emerg Med. 1988;6(5):443-448. (Retrospective; 109 patients)

  41. Lecky F, Bryden D, Little R, et al. Emergency intubation for acutely ill and injured patients. Cochrane Database Syst Rev. 2008(2):CD001429. (Review)

  42. Haut ER, Kalish BT, Cotton BA, et al. Prehospital intravenous fluid administration is associated with higher mortality in trauma patients: a National Trauma Data Bank analysis. Ann Surg. 2011;253(2):371-377. (Retrospective; 776,734 patients)

  43. Cotton BA, Jerome R, Collier BR, et al. Guidelines for pre-hospital fluid resuscitation in the injured patient. J Trauma. 2009;67(2):389-402. (Guideline)

  44. Ball CG, Wyrzykowski AD, Kirkpatrick AW, et al. Thoracic needle decompression for tension pneumothorax: clinical correlation with catheter length. Can J Surg. 2010;53(3):184- 188. (Retrospective review; 9689 patients)

  45. Ferrie EP, Collum N, McGovern S. The right place in the right space? Awareness of site for needle thoracocentesis. Emerg Med J. 2005;22(11):788-789. (Prospective observational; 24 patients)

  46. Gilligan P, Hegarty D, Hassan TB. The point of the needle. Occult pneumothorax: a review. Emerg Med J. 2003;20(3):293- 296. (Review)

  47. Holcomb JB, McManus JG, Kerr ST, et al. Needle versus tube thoracostomy in a swine model of traumatic tension hemopneumothorax. Prehosp Emerg Care. 2009;13(1):18-27. (Animal study)

  48. Inaba K, Ives C, McClure K, et al. Radiologic evaluation of alternative sites for needle decompression of tension pneumothorax. Arch Surg. 2012;147(9):813-818. (Retrospective; 680 patients)

  49. Martin M, Satterly S, Inaba K, et al. Does needle thoracostomy provide adequate and effective decompression of tension pneumothorax? J Trauma Acute Care Surg. 2012;73(6):1412- 1417. (Animal model)

  50. Rathinam S, Bleetman A, Steyn RS. Needle thoracostomy in treatment of a tension pneumothorax in trauma patients. J Trauma. 2008;65(4):964. (Communication)

  51. Stevens RL, Rochester AA, Busko J, et al. Needle thoracostomy for tension pneumothorax: failure predicted by chest computed tomography. Prehosp Emerg Care. 2009;13(1):14-17. (Retrospective; 110 patients)

  52. Zengerink I, Brink PR, Laupland KB, et al. Needle thoracostomy in the treatment of a tension pneumothorax in trauma patients: what size needle? J Trauma. 2008;64(1):111-114. (Retrospective; 774 patients)

  53. Eckstein M, Suyehara D. Needle thoracostomy in the prehospital setting. Prehosp Emerg Care. 1998;2(2):132-135. (Prospective observational; 108 patients)

  54. Salim A, Sangthong B, Martin M, et al. Whole body imaging in blunt multisystem trauma patients without obvious signs of injury: results of a prospective study. Arch Surg. 2006;141(5):468- 473. (Prospective observational; 1000 patients)

  55. * Rodriguez RM, Anglin D, Langdorf MI, et al. NEXUS Chest: validation of a decision instrument for selective chest imaging in blunt trauma. JAMA Surg. 2013;148(10):940-946. (Prospective multicenter; 9905 patients)

  56. Gonzalez KW, Ghneim MH, Kang F, et al. A pilot single-institution predictive model to guide rib fracture management in elderly patients. J Trauma Acute Care Surg. 2015;78(5):970-975. (Retrospective; 400 patients)

  57. Ferraris VA, Bernard AC, Hyde B. The impact of antiplatelet drugs on trauma outcomes. J Trauma Acute Care Surg. 2012;73(2):492-497. (Retrospective; 11,374 patients)

  58. Bonville DJ, Ata A, Jahraus CB, et al. Impact of preinjury warfarin and antiplatelet agents on outcomes of trauma patients. Surgery. 2011;150(4):861-868. (Retrospective review; 456 patients)

  59. Millo NZ, Plewes C, Rowe BH, et al. Appropriateness of CT of the chest, abdomen, and pelvis in motorized blunt force trauma patients without signs of significant injury. AJR Am J Roentgenol. 2011;197(6):1393-1398. (Retrospective; 542 patients)

  60. Holmes JF, Ngyuen H, Jacoby RC, et al. Do all patients with left costal margin injuries require radiographic evaluation for intraabdominal injury? Ann Emerg Med. 2005;46(3):232- 236. (Prospective; 875 patients)

  61. * Chung JH, Cox CW, Mohammed TL, et al. ACR appropriateness criteria blunt chest trauma. J Am Coll Radiol. 2014;11(4):345-351. (Guideline/review)

  62. Kea B, Gamarallage R, Vairamuthu H, et al. What is the clinical significance of chest CT when the chest x-ray result is normal in patients with blunt trauma? Am J Emerg Med. 2013;31(8):1268-1273. (Observational; 791 patients)

  63. Wisbach GG, Sise MJ, Sack DI, et al. What is the role of chest x-ray in the initial assessment of stable trauma patients? J Trauma. 2007;62(1):74-78. (Retrospective review; 1000 patients)

  64. Barrios C, Malinoski D, Dolich M, et al. Utility of thoracic computed tomography after blunt trauma: when is chest radiograph enough? Am Surg. 2009;75(10):966-969. (Retrospective; 200 patients)

  65. Hoffstetter P, Dornia C, Schafer S, et al. Diagnostic significance of rib series in minor thorax trauma compared to plain chest film and computed tomography. J Trauma Manag Outcomes. 2014;8:10. (Retrospective; 56 patients)

  66. Hoffstetter P, Dornia C, Wagner M, et al. Clinical significance of conventional rib series in patients with minor thoracic trauma. Rofo. 2014;186(9):876-880. (Retrospective; 669 patients)

  67. Ho ML, Gutierrez FR. Chest radiography in thoracic polytrauma. AJR Am J Roentgenol. 2009;192(3):599-612. (Review)

  68. Alrajhi K, Woo MY, Vaillancourt C. Test characteristics of ultrasonography for the detection of pneumothorax: a systematic review and meta-analysis. Chest. 2012;141(3):703-708. (Systematic review)

  69. Wilkerson RG, Stone MB. Sensitivity of bedside ultrasound and supine anteroposterior chest radiographs for the identification of pneumothorax after blunt trauma. Acad Emerg Med. 2010;17(1):11-17. (Systematic review)

  70. Hyacinthe AC, Broux C, Francony G, et al. Diagnostic accuracy of ultrasonography in the acute assessment of common thoracic lesions after trauma. Chest. 2012;141(5):1177-1183. (Prospective observational; 119 patients)

  71. Leblanc D, Bouvet C, Degiovanni F, et al. Early lung ultrasonography predicts the occurrence of acute respiratory distress syndrome in blunt trauma patients. Intensive Care Med. 2014;40(10):1468-1474. (Prospective observational; 45 patients)

  72. * Brenner DJ, Hall EJ. Computed tomography--an increasing source of radiation exposure. N Engl J Med. 2007;357(22):2277-2284. (Epidemiological review and theoretical model)

  73. Mitchell AM, Kline JA, Jones AE, et al. Major adverse events one year after acute kidney injury after contrast-enhanced computed tomography. Ann Emerg Med. 2015. (Prospective observational; 633 patients)

  74. * Smith-Bindman R, Lipson J, Marcus R, et al. Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch Intern Med. 2009;169(22):2078-2086. (Retrospective; 1119 patients)

  75. Berrington de Gonzalez A, Mahesh M, Kim KP, et al. Projected cancer risks from computed tomographic scans performed in the United States in 2007. Arch Intern Med. 2009;169(22):2071-2077. (Theoretic risk model study of cancer risk)

  76. Livingston DH, Shogan B, John P, et al. CT diagnosis of rib fractures and the prediction of acute respiratory failure. J Trauma. 2008;64(4):905-911. (Retrospective; 388 patients)

  77. * Rodriguez RM, Baumann BM, Raja AS, et al. Diagnostic yields, charges, and radiation dose of chest imaging in blunt trauma evaluations. Acad Emerg Med. 2014;21(6):644-650. (Prospective observational; 9905 patients)

  78. Namias N, McKenney MG, Martin LC. Utility of admission chemistry and coagulation profiles in trauma patients: a reappraisal of traditional practice. J Trauma. 1996;41(1):21-25. (Prospective observational; 500 patients)

  79. Tortella BJ, Lavery RF, Rekant M. Utility of routine admission serum chemistry panels in adult trauma patients. Acad Emerg Med. 1995;2(3):190-194. (Retrospective review; 913 patients)

  80. Asimos AW, Gibbs MA, Marx JA, et al. Value of point-of-care blood testing in emergent trauma management. J Trauma. 2000;48(6):1101-1108. (Prospective; 200 patients)

  81. Odom SR, Howell MD, Silva GS, et al. Lactate clearance as a predictor of mortality in trauma patients. J Trauma Acute Care Surg. 2013;74(4):999-1004. (Prospective; 4742 patients)

  82. Pal JD, Victorino GP, Twomey P, et al. Admission serum lactate levels do not predict mortality in the acutely injured patient. J Trauma. 2006;60(3):583-587. (Prospective; 5995 patients)

  83. Herbert HK, Dechert TA, Wolfe L, et al. Lactate in trauma: a poor predictor of mortality in the setting of alcohol ingestion. Am Surg. 2011;77(12):1576-1579. (Retrospective; 1083 patients)

  84. Manikis P, Jankowski S, Zhang H, et al. Correlation of serial blood lactate levels to organ failure and mortality after trauma. Am J Emerg Med. 1995;13(6):619-622. (Retrospective; 129 patients)

  85. Regnier MA, Raux M, Le Manach Y, et al. Prognostic significance of blood lactate and lactate clearance in trauma patients. Anesthesiology. 2012;117(6):1276-1288. (Prospective observational; 586 patients)

  86. Dezman ZD, Comer AC, Smith GS, et al. Failure to clear elevated lactate predicts 24-hour mortality in trauma patients. J Trauma Acute Care Surg. 2015;79(4):580-585. (Retrospective; 3887 patients)

  87. Clancy K, Velopulos C, Bilaniuk JW, et al. Screening for blunt cardiac injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012;73(5 Suppl 4):S301-S306. (Guideline)

  88. Beckers SK, Brokmann JC, Rossaint R. Airway and ventilator management in trauma patients. Curr Opin Crit Care. 2014;20(6):626-631. (Review)

  89. Richter T, Ragaller M. Ventilation in chest trauma. J Emerg Trauma Shock. 2011;4(2):251-259. (Review)

  90. Gallagher JJ. Management of blunt pulmonary injury. AACN Adv Crit Care. 2014;25(4):375-386. (Review)

  91. Chiumello D, Coppola S, Froio S, et al. Noninvasive ventilation in chest trauma: systematic review and meta-analysis. Intensive Care Med. 2013;39(7):1171-1180. (Meta-analysis; 5 studies, 219 patients)

  92. Carrier FM, Turgeon AF, Nicole PC, et al. Effect of epidural analgesia in patients with traumatic rib fractures: a systematic review and meta-analysis of randomized controlled trials. Can J Anaesth. 2009;56(3):230-242. (Meta-analysis)

  93. Yoshida H, Yaguchi S, Matsumoto A, et al. A modified paravertebral block to reduce risk of mortality in a patient with multiple rib fractures. Am J Emerg Med. 2015;33(5):e733-e734. (Case report)

  94. Ho AM, Karmakar MK, Critchley LA. Acute pain management of patients with multiple fractured ribs: a focus on regional techniques. Curr Opin Crit Care. 2011;17(4):323-327. (Review)

  95. Mohta M, Verma P, Saxena AK, et al. Prospective, randomized comparison of continuous thoracic epidural and thoracic paravertebral infusion in patients with unilateral multiple fractured ribs--a pilot study. J Trauma. 2009;66(4):1096-1101. (Randomized controlled trial; 30 patients)

  96. Tainter CR. An evidence-based approach to traumatic pain management in the emergency department. Emerg Med Pract. 2012;14(8):1-26. (Review)

  97. Pieracci FM, Rodil M, Stovall RT, et al. Surgical stabilization of severe rib fractures. J Trauma Acute Care Surg. 2015;78(4):883-887. (Review)

  98. Oyetunji TA, Jackson HT, Obirieze AC, et al. Associated injuries in traumatic sternal fractures: a review of the National Trauma Data Bank. Am Surg. 2013;79(7):702-705. (Retrospec¬tive; 23,985 patients)

  99. Perez MR, Rodriguez RM, Baumann BM, et al. Sternal fracture in the age of pan-scan. Injury. 2015;46(7):1324-1327. (Retrospective; 292 patients)

  100. Dua A, McMaster J, Desai PJ, et al. The association between blunt cardiac injury and isolated sternal fracture. Cardiol Res Pract. 2014;2014:629687. (Retrospective; 88 patients)

  101. Baldwin KD, Ohman-Strickland P, Mehta S, et al. Scapula fractures: a marker for concomitant injury? A retrospective review of data in the National Trauma Database. J Trauma. 2008;65(2):430-435. (Retrospective case control; 12,181 patients)

  102. Brown CV, Velmahos G, Wang D, et al. Association of scapular fractures and blunt thoracic aortic injury: fact or fiction? Am Surg. 2005;71(1):54-57. (Retrospective; 35,541 patients)

  103. Glass ER, Thompson JD, Cole PA, et al. Treatment of sternoclavicular joint dislocations: a systematic review of 251 dislocations in 24 case series. J Trauma. 2011;70(5):1294-1298. (Systematic review; 24 case studies, 251 patients)

  104. Clemency BM, Tanski CT, Rosenberg M, et al. Sufficient catheter length for pneumothorax needle decompression: a meta-analysis. Prehosp Disaster Med. 2015;30(3):249-253. (Meta-analysis)

  105. Dominguez KM, Ekeh AP, Tchorz KM, et al. Is routine tube thoracostomy necessary after prehospital needle decompression for tension pneumothorax? Am J Surg. 2013;205(3):329- 332. (Prospective observational; 41 patients)

  106. Fitzgerald M, Mackenzie CF, Marasco S, et al. Pleural decompression and drainage during trauma reception and resuscitation. Injury. 2008;39(1):9-20. (Review)

  107. Massarutti D, Trillo G, Berlot G, et al. Simple thoracostomy in prehospital trauma management is safe and effective: a 2-year experience by helicopter emergency medical crews. Eur J Emerg Med. 2006;13(5):276-280. (Prospective observational; 55 patients)

  108. Deakin CD, Davies G, Wilson A. Simple thoracostomy avoids chest drain insertion in prehospital trauma. J Trauma. 1995;39(2):373-374. (Prospective observational; 45 patients)

  109. Benns MV, Egger ME, Harbrecht BG, et al. Does chest tube location matter? An analysis of chest tube position and the need for secondary interventions. J Trauma Acute Care Surg. 2015;78(2):386-390. (Retrospective review; 291 patients)

  110. Rivera L, O’Reilly EB, Sise MJ, et al. Small catheter tube thoracostomy: effective in managing chest trauma in stable patients. J Trauma. 2009;66(2):393-399. (Retrospective; 565 patients)

  111. Iepsen UW, Ringbaek T. Small-bore chest tubes seem to perform better than larger tubes in treatment of spontaneous pneumothorax. Dan Med J. 2013;60(6):A4644. (Retrospective; 104 patients)

  112. Kulvatunyou N, Joseph B, Friese RS, et al. 14 French pigtail catheters placed by surgeons to drain blood on trauma patients: is 14-Fr too small? J Trauma Acute Care Surg. 2012;73(6):1423-1427. (Prospective observational; 36 patients)

  113. Kulvatunyou N, Erickson L, Vijayasekaran A, et al. Randomized clinical trial of pigtail catheter versus chest tube in injured patients with uncomplicated traumatic pneumothorax. Br J Surg. 2014;101(2):17-22. (Randomized controlled trial; 40 patients)

  114. Inaba K, Lustenberger T, Recinos G, et al. Does size matter? A prospective analysis of 28-32 versus 36-40 French chest tube size in trauma. J Trauma Acute Care Surg. 2012;72(2):422- 427. (Prospective observational; 353 patients)

  115. Lee RK, Graham CA, Yeung JH, et al. Occult pneumothoraces in Chinese patients with significant blunt chest trauma: radiological classification and proposed clinical significance. Injury. 2012;43(12):2105-2108. (Retrospective; 36 patients)

  116. Wilson H, Ellsmere J, Tallon J, et al. Occult pneumothorax in the blunt trauma patient: tube thoracostomy or observation? Injury. 2009;40(9):928-931. (Retrospective; 1881 patients)

  117. Kirkpatrick AW, Rizoli S, Ouellet JF, et al. Occult pneumothoraces in critical care: a prospective multicenter randomized controlled trial of pleural drainage for mechanically ventilated trauma patients with occult pneumothoraces. J Trauma Acute Care Surg. 2013;74(3):747-754. (Randomized controlled trial; 90 patients)

  118. Yadav K, Jalili M, Zehtabchi S. Management of traumatic occult pneumothorax. Resuscitation. 2010;81(9):1063-1068. (Systematic review)

  119. Wells BJ, Roberts DJ, Grondin S, et al. To drain or not to drain? Predictors of tube thoracostomy insertion and outcomes associated with drainage of traumatic hemothoraces. Injury. 2015;46(9):1743-1748. (Retrospective cohort; 635 patients)

  120. ATLS Subcommittee, American College of Surgeons’ Committee on Trauma, International Working Group. Advanced trauma life support (ATLS®): the ninth edition. J Trauma Acute Care Surg. 2013;74(5):1363-1366. (Guideline)

  121. Richardson JD, Adams L, Flint LM. Selective management of flail chest and pulmonary contusion. Ann Surg. 1982;196(4):481-487. (Retrospective 427 patients)

  122. Alexander JQ, Gutierrez CJ, Mariano MC, et al. Blunt chest trauma in the elderly patient: how cardiopulmonary disease affects outcome. Am Surg. 2000;66(9):855-857. (Retrospective review; 62 patients)

  123. Stawicki SP, Grossman MD, Hoey BA, et al. Rib fractures in the elderly: a marker of injury severity. J Am Geriatr Soc. 2004;52(5):805-808. (Retrospective; 8648 patients)

  124. Keller JM, Sciadini MF, Sinclair E, et al. Geriatric trauma: demographics, injuries, and mortality. J Orthop Trauma. 2012;26(9):e161-e165. (Retrospective; 597 patients)

  125. Battle CE, Hutchings H, James K, et al. The risk factors for the development of complications during the recovery phase following blunt chest wall trauma: a retrospective study. Injury. 2013;44(9):1171-1176. (Retrospective; 174 patients)

  126. Shields JF, Emond M, Guimont C, et al. Acute minor thoracic injuries: evaluation of practice and follow-up in the emergency department. Can Fam Physician. 2010;56(3):e117-e124. (Retrospective; 447 patients)

  127. Bulger EM, Arneson MA, Mock CN, et al. Rib fractures in the elderly. J Trauma. 2000;48(6):1040-1046. (Retrospective; 277 patients)

  128. Battle C, Hutchings H, Lovett S, et al. Predicting outcomes after blunt chest wall trauma: development and external validation of a new prognostic model. Crit Care. 2014;18(3):R98. (Retrospective and prospective observational decision instrument study; 511 patients)

  129. Gupta M, Schriger DL, Hiatt JR, et al. Selective use of computed tomography compared with routine whole body imaging in patients with blunt trauma. Ann Emerg Med. 2011;58(5):407-416. (Observational study; 701 patients)

  130. * Langdorf MI, Medak AJ, Hendey GW, et al. Prevalence and clinical import of thoracic injury identified by chest computed tomography but not chest radiography in blunt trauma: multicenter prospective cohort study. Ann Emerg Med. 2015;66(6):589-600. (Prospective observational; 5912 patients)

  131. Rodriguez RM, Langdorf MI, Nishijima D, et al. Derivation and validation of two decision instruments for selective chest CT in blunt trauma: a multicenter prospective observational study (NEXUS Chest CT). PLoS Med. 2015;12(10):e1001883. (Prospective; 11,477 patients)

  132. * Caputo ND, Stahmer C, Lim G, et al. Whole-body computed tomographic scanning leads to better survival as opposed to selective scanning in trauma patients: a systematic review and meta-analysis. J Trauma Acute Care Surg. 2014;77(4):534- 539. (Systematic review)

  133. Van Vugt R, Keus F, Kool D, et al. Selective computed tomography (CT) versus routine thoracoabdominal CT for high-energy blunt-trauma patients. Cochrane Database Syst Rev. 2013;12:CD009743. (Systematic Cochrane review)
Publication Information

Eric J. Morley, MD, MS ; Scott Johnson, MD; Evan Leibner, MD, PhD; Jawad Shahid, MD;

Publication Date

June 1, 2016

CME Expiration Date

July 1, 2019

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