Traumatic pneumothorax: is a chest drain always necessary?

OBJECTIVE: To examine the management of traumatic pneumothorax in a department where some of these injuries do not receive chest drains. METHODS: A retrospective study of the management of traumatic pneumothorax was performed on a unit where historically many of these injuries have been treated conservatively. RESULTS: 54 pneumothoraces in a three year period were identified. Of these, 29 injuries (54.7%) were initially managed without drainage. Two patients subsequently had chest drains inserted as a result of asymptomatic radiological enlargement of the pneumothorax while inpatients. No patients deteriorated clinically during conservative treatment. CONCLUSIONS: Chest drain insertion for small or moderate sized traumatic pneumothoraces, in the absence of other significant injuries or the need for intermittent positive pressure ventilation (IPPV), may be unnecessary.