Predictors of Pleural Decompression in Blunt Traumatic Occult Hemothorax: A Retrospective Study

Document Type : Original Article


1 Department of Surgery, Prince of Songkla University, Hat Yai, Songkhla, Thailand

2 Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand

3 Department of Radiology, Prince of Songkla University, Hat Yai, Songkhla, Thailand

4 Research Unit of Holistic Health and Safety Management in Community, Prince of Songkla University, Hat Yai, Songkhla, Thailand



Background: The increased use of computed tomography (CT) results in higher occult hemothorax detection in blunt chest trauma. The indication for pleural decompression is not well defined. This research aims to study the overall factors determining pleural decompression. Methods: All blunt chest injury patients were retrospectively reviewed from the institutional trauma registry. Patients who underwent chest or whole‑abdomen CT within 24 h were reviewed by a radiologist to identify initial occult hemothorax defined as a negative chest X‑ray with the presence of hemothorax in the CT. The data included demographic data, mechanism of injury, complications, treatments, and characteristics of the hemothorax from the CT. Results: Six hundred and eighty-six blunt chest injury patients were reviewed over a period of 30 months. Eighty‑one (24.9%) patients had occult hemothorax. The mean time from injury to CT was 5.7 h. Most patients (87.6%) were male. Most patients (70.2%) suffered from traffic collisions and 84.4% had rib fractures. Pleural decompression was performed in 25 patients who had significantly thicker hemothorax (1.1 cm vs. 0.8 cm, P < 0.01), higher rate of occult pneumothorax (88% vs. 53.8%, P < 0.01), and lung contusion (44% vs. 15%, P < 0.05) than those who did not undergo decompression. Multivariable logistic regression showed that a thickness of hemothorax >1.1 cm was associated with increased risk of pleural decompression (odds ratio [OR]: 5.51, 95% confidence interval [CI]: 1.42–21.42) and occult pneumothorax (OR: 6.93, 95% CI: 1.56–30.77). Conclusions: Drainage of occult hemothorax after blunt chest trauma was significantly associated with concomitant occult pneumothorax, lung contusion, and hemothorax thicker than 1.1 cm.


1. Khandhar SJ, Johnson SB, Calhoon JH. Overview of thoracic trauma in the United States. Thorac Surg Clin 2007;17:1‑9.
2. Bilello JF, Davis JW, Lemaster DM. Occult traumatic hemothorax: When can sleeping dogs lie? Am J Surg 2005;190:841‑4.
3. Stafford RE, Linn J, Washington L. Incidence and management of occult hemothoraces. Am J Surg 2006;192:722‑6.
4. Mahmood I, Abdelrahman H, Al‑Hassani A, Nabir S, Sebastian M, Maull K. Clinical management of occult hemothorax: A prospective study of 81 patients. Am J Surg 2011;201:766‑9.
5. Deneuville M. Morbidity of percutaneous tube thoracostomy in trauma patients. Eur J Cardiothorac Surg 2002;22:673‑8.
6. Misthos P, Kakaris S, Sepsas E, Athanassiadi K, Skottis I. A prospective analysis of occult pneumothorax, delayed pneumothorax and delayed hemothorax after minor blunt thoracic trauma. Eur J Cardiothorac Surg 2004;25:859‑64.
7. Poole GV, Morgan DB, Cranston PE, Muakkassa FF, Griswold JA. Computed tomography in the management of blunt thoracic trauma. J Trauma 1993;35:296‑300.
8. Moussavi N, Ghani H, Davoodabadi A, Atoof F, Moravveji A, Saidfar S, et al. Routine versus selective chest and abdominopelvic CT‑scan in conscious blunt trauma patients: A randomized controlled study. Eur J Trauma Emerg Surg 2018;44:9‑14.
9. Menger R, Telford G, Kim P, Bergey MR, Foreman J, Sarani B, et al. Complications following thoracic trauma managed with tube thoracostomy. Injury 2012;43:46‑50.