The safety of selective conservatism in the management of small pneumothoraces following 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) remains controversial. Methods A prospective study was conducted over a 15-year period on patients with isolated thoracic SWs with small PTX on chest radiograph (CXR) (< 2 cm) and who were asymptomatic. These patients did not undergo tube thoracostomy (TT) but rather active clinical observation at a major trauma centre in South Africa. Results Two hundred and eighty-four patients were included (91% male, mean age: 24 yrs). Eight (3%) eventually required TT: three deteriorated clinically and five demonstrated radiological progression of PTX on interval CXR. Of these eight patients who required TT, six (75%) had multiple SWs. All eight patients had uneventful recovery. All other patients who were managed successfully with clinical observation alone were discharged home. No patients represented to the hospital following discharge. There was no morbidity or mortality as a direct result of our selective conservative management approach. Conclusion Selective conservative management of patients with asymptomatic small PTX < 2 cm following thoracic SWs appeared to be safe. The vast majority of these patients do not require TT. Active clinical observation alone by an experienced clinician is sufficient.