{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T16:26:37Z","timestamp":1785342397984,"version":"3.55.0"},"reference-count":74,"publisher":"Hamad bin Khalifa University Press (HBKU Press)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,3,16]]},"abstract":"<jats:p>\n                    <jats:bold>Background:<\/jats:bold>\n                    We aimed to assess the management and outcome of occult pneumothorax and to determine the factors associated with failure of observational management in patients with blunt chest trauma (BCT).\n                    <jats:bold>Methods:<\/jats:bold>\n                    Patients with BCT were retrospectively identified from the trauma database over 4 years. Data were analyzed and compared on the basis of initial management (conservative vs. tube thoracostomy).\n                    <jats:bold>Results:<\/jats:bold>\n                    Across the study period, 1928 patients were admitted with BCT, of which 150 (7.8%) patients were found to have occult pneumothorax. The mean patient age was 32.8\u00a0\u00b1\u00a013.7\u00a0years, and the majority were male (86.7%). Positive-pressure ventilation (PPV) was required in 32 patients, and bilateral occult pneumothorax was seen in 25 patients. In 85.3% (n\u00a0=\u00a0128) of cases, occult pneumothorax was managed conservatively, whereas 14.7% (n\u00a0=\u00a022) underwent tube thoracostomy. Five patients had failed observational treatment requiring delayed tube thoracostomy. Pneumonia was reported in 12.8% of cases. Compared with those who were treated conservatively, patients who underwent tube thoracostomy had thicker pneumothoraxes and a higher rate of lung contusion, rib fracture, pneumonia, prolonged ventilatory days, and prolonged hospital length of stay. Overall mortality was 4.0%. The deceased had more polytrauma and were treated conservatively without a chest tube. Patients who failed conservative management had a higher frequency of lung contusion, greater pneumothorax thickness, higher Injury Severity Scores (ISS), and required more PPV.\n                    <jats:bold>Conclusions:<\/jats:bold>\n                    Occult pneumothorax is not uncommon in BCT and can be successfully managed conservatively with a close clinical follow-up. Intervention should be limited to patients who have an increase in size of the pneumothorax on follow-up or become symptomatic under observation. Patients who fail conservative management may have a greater pneumothorax thickness and higher ISS. However, large prospective studies are warranted to support these findings and to establish the institutional guidelines for the management of occult pneumothorax.\n                  <\/jats:p>","DOI":"10.5339\/qmj.2020.10","type":"journal-article","created":{"date-parts":[[2020,3,24]],"date-time":"2020-03-24T01:30:46Z","timestamp":1585013446000},"source":"Crossref","is-referenced-by-count":14,"title":["Occult Pneumothorax in Patients Presenting with Blunt Chest Trauma: An Observational Analysis"],"prefix":"10.5339","volume":"2020","author":[{"given":"Ismail","family":"Mahmood","sequence":"first","affiliation":[{"name":"Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basil","family":"Younis","sequence":"additional","affiliation":[{"name":"Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khalid","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fuad","family":"Mustafa","sequence":"additional","affiliation":[{"name":"Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayman","family":"El-Menyar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Alabdallat","sequence":"additional","affiliation":[{"name":"Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashok","family":"Parchani","sequence":"additional","affiliation":[{"name":"Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruben","family":"Peralta","sequence":"additional","affiliation":[{"name":"Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syed","family":"Nabir","sequence":"additional","affiliation":[{"name":"Department of Radiology, Hamad General Hospital, Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadeem","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Radiology, Hamad General Hospital, Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hassan","family":"Al-Thani","sequence":"additional","affiliation":[{"name":"Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3277","reference":[{"key":"CIT0001","series-title":"J Trauma.","first-page":"924","article-title":"Incidence, risk factors, and outcomes for occult pneumothoraces in victims of major trauma","volume":"59(4)","author":"Ball\n\u00a0\nCG","year":"2005"},{"key":"CIT0002","series-title":"Crit Care Med.","first-page":"677","article-title":"Radiographic recognition of pneumothorax in the intensive care unit","volume":"14","author":"Chiles\n\u00a0\nC","year":"1986"},{"key":"CIT0003","series-title":"Am J Roentgenol.","first-page":"901","article-title":"Distribution of pneumothorax in the supine and semirecumbent critically ill adult","volume":"144","author":"Tocino\n\u00a0\nIM","year":"1985"},{"key":"CIT0004","series-title":"Ann Radiol.","first-page":"121","article-title":"Radiological management of blunt polytrauma with CT and angiography: an integrated approach","volume":"30","author":"Kurdziel\n\u00a0\nJC","year":"1987"},{"issue":"4","key":"CIT0005","series-title":"Quant Imaging Med Surg.","first-page":"618","article-title":"Bedside ultrasonography for diagnosis of pneumothorax","volume":"5","author":"Chen\n\u00a0\nL","year":"2015"},{"issue":"5","key":"CIT0006","series-title":"Can J Surg.","first-page":"E173","article-title":"The occult pneumothorax: what have we learned?","volume":"52","author":"Ball\n\u00a0\nCG","year":"2009"},{"issue":"5","key":"CIT0007","series-title":"Can J Surg.","first-page":"373","article-title":"Canadian Trauma Trials Collaborative. Occult pneumothorax in the mechanically ventilated trauma patient","volume":"46","author":"Ball\n\u00a0\nCG","year":"2003"},{"key":"CIT0008","series-title":"J Trauma Manag Outcomes","first-page":"12","article-title":"Occult pneumothorax, revisited","volume":"4","author":"Omar\n\u00a0\nHR","year":"2010 Oct"},{"issue":"6","key":"CIT0009","series-title":"Can J Surg.","first-page":"450","article-title":"Chest tube complications: how well are we training our residents?","volume":"50","author":"Ball\n\u00a0\nCG","year":"2007"},{"issue":"2","key":"CIT0010","series-title":"J Trauma.","first-page":"510","article-title":"Practice management guidelines for management of hemothorax and occult pneumothorax","volume":"70","author":"Mowery\n\u00a0\nNT","year":"2011"},{"key":"CIT0011","series-title":"Advanced trauma life support program for doctors","year":"2013"},{"key":"CIT0012","series-title":"Crit Care Res Pract.","first-page":"2019","article-title":"Factors associated with chest tube placement in blunt trauma patients with an occult pneumothorax","author":"Michaeli\n\u00a0\nP","year":"2019"},{"issue":"3","key":"CIT0013","series-title":"Singapore Med J.","first-page":"150","article-title":"Management of computed tomography-detected pneumothorax in patients with blunt trauma: experience from a community-based hospital","volume":"59","author":"Hefny\n\u00a0\nAF","year":"2018"},{"issue":"3","key":"CIT0014","series-title":"Can J Surg.","first-page":"177","article-title":"Occult pneumothoraces in ventilated pediatric trauma patients: a review","volume":"58","author":"Fulton\n\u00a0\nC","year":"2015"},{"issue":"3","key":"CIT0015","series-title":"J Trauma Acute Care Surg.","first-page":"747","article-title":"Canadian Trauma Trials Collaborative and the Research Committee of the Trauma Association of Canada. Occult pneumothoraces in critical care: a prospective multicenter randomized controlled trial of pleural drainage for mechanically ventilated trauma patients with occult pneumothoraces","volume":"74","author":"Kirkpatrick\n\u00a0\nAW","year":"2013"},{"key":"CIT0016","series-title":"J Trauma.","first-page":"13","article-title":"Occult pneumothorax in trauma patients: development of an objective scoring system","volume":"63","author":"De Moya\n\u00a0\nMA","year":"2007"},{"key":"CIT0017","series-title":"Am J Infect Control.","first-page":"128","article-title":"CDC definitions for nosocomial infections","volume":"16","author":"Garner\n\u00a0\nJS","year":"1988"},{"issue":"6","key":"CIT0018","series-title":"Ann Thorac Surg.","first-page":"2019","article-title":"Tube thoracostomy: the struggle to the standard of care","volume":"86","author":"Monaghan\n\u00a0\nSF","year":"2008"},{"key":"CIT0019","series-title":"Eur J Cardiothorac Surg.","first-page":"673","article-title":"Morbidity of 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management","volume":"58","author":"Collins\n\u00a0\nJC","year":"1992"},{"issue":"5","key":"CIT0024","series-title":"J Trauma.","first-page":"1019","article-title":"Blunt traumatic occult pneumothorax: is observation safe?-results of a prospective, AAST multicenter study","volume":"70","author":"Moore\n\u00a0\nFO","year":"2011"},{"key":"CIT0025","series-title":"J Trauma.","first-page":"631","article-title":"The increasing use of chest computed tomography for trauma: is it being over utilized?","volume":"62","author":"Plurad\n\u00a0\nD","year":"2007"},{"issue":"5","key":"CIT0026","series-title":"J Trauma.","first-page":"726","article-title":"Tube thoracostomy for occult pneumothorax: a prospective randomized study of its use","volume":"35","author":"Enderson\n\u00a0\nBL","year":"1993"},{"issue":"2","key":"CIT0027","series-title":"J Emerg Med.","first-page":"179","article-title":"CT detection of occult pneumothorax in multiple trauma patients","volume":"11","author":"Bridges\n\u00a0\nKG","year":"1993"},{"key":"CIT0028","series-title":"Am Surg.","first-page":"660","article-title":"Efficacy of thoracic computerized tomography in blunt chest trauma","volume":"67","author":"Omert\n\u00a0\nL","year":"2001"},{"issue":"9354","key":"CIT0029","series-title":"Lancet.","first-page":"332","article-title":"Ventilator-associated lung injury","volume":"361","author":"Pinhu\n\u00a0\nL","year":"2003"},{"issue":"9","key":"CIT0030","series-title":"Mayo Clin Proc.","first-page":"1382","article-title":"Mechanical Ventilation: State of the Art","volume":"92","author":"Pham\n\u00a0\nT","year":"2017"},{"issue":"10","key":"CIT0031","series-title":"Am Surg.","first-page":"958","article-title":"Successful management of occult pneumothorax without tube thorocostomy despite positive pressure ventilation","volume":"74","author":"Barrios\n\u00a0\nC","year":"2008"},{"issue":"8","key":"CIT0032","series-title":"Int J Sci Stud.","first-page":"147","article-title":"Role of conservative management of traumatic chest injuries: a retrospective study & review of literature","volume":"3","author":"Pramod\n\u00a0\nT","year":"2015"},{"issue":"9","key":"CIT0033","series-title":"Resuscitation","first-page":"1063","article-title":"Management of traumatic occult pneumothorax","volume":"81","author":"Yadav\n\u00a0\nK","year":"2010"},{"issue":"6","key":"CIT0034","series-title":"Eur J Trauma Emerg Surg.","first-page":"785","article-title":"Occult pneumothorax in blunt trauma: is there a need for tube thoracostomy?","volume":"42","author":"Zhang\n\u00a0\nM","year":"2016"},{"key":"CIT0035","series-title":"Injury","first-page":"492","article-title":"Occult pneumothorax in Chinese patients with significant blunt chest trauma: incidence and management","volume":"41","author":"Lee\n\u00a0\nKL","year":"2010"},{"issue":"9","key":"CIT0036","series-title":"Injury","first-page":"928","article-title":"Occult pneumothorax in the blunt trauma patient: tube thoracostomy or observation?","volume":"40","author":"Wilson\n\u00a0\nH","year":"2009"},{"key":"CIT0037","series-title":"Emerg Med Int.","first-page":"2015","article-title":"Outcome of concurrent occult hemothorax and pneumothorax in trauma patients who required assisted ventilation","author":"Mahmood\n\u00a0\nI","year":"2015"},{"key":"CIT0001","series-title":"J Trauma.","first-page":"924","article-title":"Incidence, risk factors, and outcomes for occult pneumothoraces in victims of major trauma","volume":"59(4)","author":"Ball\n\u00a0\nCG","year":"2005"},{"key":"CIT0002","series-title":"Crit Care Med.","first-page":"677","article-title":"Radiographic recognition of pneumothorax in the intensive care unit","volume":"14","author":"Chiles\n\u00a0\nC","year":"1986"},{"key":"CIT0003","series-title":"Am J Roentgenol.","first-page":"901","article-title":"Distribution of pneumothorax in the supine and semirecumbent critically ill adult","volume":"144","author":"Tocino\n\u00a0\nIM","year":"1985"},{"key":"CIT0004","series-title":"Ann Radiol.","first-page":"121","article-title":"Radiological management of blunt polytrauma with CT and angiography: an integrated approach","volume":"30","author":"Kurdziel\n\u00a0\nJC","year":"1987"},{"issue":"4","key":"CIT0005","series-title":"Quant Imaging Med Surg.","first-page":"618","article-title":"Bedside ultrasonography for diagnosis of pneumothorax","volume":"5","author":"Chen\n\u00a0\nL","year":"2015"},{"issue":"5","key":"CIT0006","series-title":"Can J Surg.","first-page":"E173","article-title":"The occult pneumothorax: what have we learned?","volume":"52","author":"Ball\n\u00a0\nCG","year":"2009"},{"issue":"5","key":"CIT0007","series-title":"Can J Surg.","first-page":"373","article-title":"Canadian Trauma Trials Collaborative. Occult pneumothorax in the mechanically ventilated trauma patient","volume":"46","author":"Ball\n\u00a0\nCG","year":"2003"},{"key":"CIT0008","series-title":"J Trauma Manag Outcomes","first-page":"12","article-title":"Occult pneumothorax, revisited","volume":"4","author":"Omar\n\u00a0\nHR","year":"2010 Oct"},{"issue":"6","key":"CIT0009","series-title":"Can J Surg.","first-page":"450","article-title":"Chest tube complications: how well are we training our residents?","volume":"50","author":"Ball\n\u00a0\nCG","year":"2007"},{"issue":"2","key":"CIT0010","series-title":"J Trauma.","first-page":"510","article-title":"Practice management guidelines for management of hemothorax and occult pneumothorax","volume":"70","author":"Mowery\n\u00a0\nNT","year":"2011"},{"key":"CIT0011","series-title":"Advanced trauma life support program for doctors","year":"2013"},{"key":"CIT0012","series-title":"Crit Care Res Pract.","first-page":"2019","article-title":"Factors associated with chest tube placement in blunt trauma patients with an occult pneumothorax","author":"Michaeli\n\u00a0\nP","year":"2019"},{"issue":"3","key":"CIT0013","series-title":"Singapore Med J.","first-page":"150","article-title":"Management of computed tomography-detected pneumothorax in patients with blunt trauma: experience from a community-based hospital","volume":"59","author":"Hefny\n\u00a0\nAF","year":"2018"},{"issue":"3","key":"CIT0014","series-title":"Can J Surg.","first-page":"177","article-title":"Occult pneumothoraces in ventilated pediatric trauma patients: a review","volume":"58","author":"Fulton\n\u00a0\nC","year":"2015"},{"issue":"3","key":"CIT0015","series-title":"J Trauma Acute Care Surg.","first-page":"747","article-title":"Canadian Trauma Trials Collaborative and the Research Committee of the Trauma Association of Canada. Occult pneumothoraces in critical care: a prospective multicenter randomized controlled trial of pleural drainage for mechanically ventilated trauma patients with occult pneumothoraces","volume":"74","author":"Kirkpatrick\n\u00a0\nAW","year":"2013"},{"key":"CIT0016","series-title":"J Trauma.","first-page":"13","article-title":"Occult pneumothorax in trauma patients: development of an objective scoring system","volume":"63","author":"De Moya\n\u00a0\nMA","year":"2007"},{"key":"CIT0017","series-title":"Am J Infect Control.","first-page":"128","article-title":"CDC definitions for nosocomial infections","volume":"16","author":"Garner\n\u00a0\nJS","year":"1988"},{"issue":"6","key":"CIT0018","series-title":"Ann Thorac Surg.","first-page":"2019","article-title":"Tube thoracostomy: the struggle to the standard of care","volume":"86","author":"Monaghan\n\u00a0\nSF","year":"2008"},{"key":"CIT0019","series-title":"Eur J Cardiothorac Surg.","first-page":"673","article-title":"Morbidity of percutaneous tube thoracostomy in trauma patients","volume":"22","author":"Deneuville\n\u00a0\nM","year":"2002"},{"key":"CIT0020","series-title":"Crit Care Med.","first-page":"1370","article-title":"Evaluation of the utility of computed tomography in the initial assessment of the critical care patient with chest trauma","volume":"28","author":"Guerrero-L\u00f3pez\n\u00a0\nF","year":"2000"},{"key":"CIT0021","series-title":"J Trauma.","first-page":"987","article-title":"Treatment of occult pneumothoraces from blunt trauma","volume":"46","author":"Brasel\n\u00a0\nKJ","year":"1999"},{"key":"CIT0022","series-title":"Am Surg.","first-page":"254","article-title":"The occult pneumothorax: an increasing entity in trauma","volume":"65","author":"Hill\n\u00a0\nSL","year":"1999"},{"key":"CIT0023","series-title":"Am Surg.","first-page":"743","article-title":"Occult traumatic pneumothorax: immediate tube thoracostomy versus expectant management","volume":"58","author":"Collins\n\u00a0\nJC","year":"1992"},{"issue":"5","key":"CIT0024","series-title":"J Trauma.","first-page":"1019","article-title":"Blunt traumatic occult pneumothorax: is observation safe?-results of a prospective, AAST multicenter study","volume":"70","author":"Moore\n\u00a0\nFO","year":"2011"},{"key":"CIT0025","series-title":"J Trauma.","first-page":"631","article-title":"The increasing use of chest computed tomography for trauma: is it being over utilized?","volume":"62","author":"Plurad\n\u00a0\nD","year":"2007"},{"issue":"5","key":"CIT0026","series-title":"J Trauma.","first-page":"726","article-title":"Tube thoracostomy for occult pneumothorax: a prospective randomized study of its use","volume":"35","author":"Enderson\n\u00a0\nBL","year":"1993"},{"issue":"2","key":"CIT0027","series-title":"J Emerg Med.","first-page":"179","article-title":"CT detection of occult pneumothorax in multiple trauma patients","volume":"11","author":"Bridges\n\u00a0\nKG","year":"1993"},{"key":"CIT0028","series-title":"Am Surg.","first-page":"660","article-title":"Efficacy of thoracic computerized tomography in blunt chest trauma","volume":"67","author":"Omert\n\u00a0\nL","year":"2001"},{"issue":"9354","key":"CIT0029","series-title":"Lancet.","first-page":"332","article-title":"Ventilator-associated lung injury","volume":"361","author":"Pinhu\n\u00a0\nL","year":"2003"},{"issue":"9","key":"CIT0030","series-title":"Mayo Clin Proc.","first-page":"1382","article-title":"Mechanical Ventilation: State of the Art","volume":"92","author":"Pham\n\u00a0\nT","year":"2017"},{"issue":"10","key":"CIT0031","series-title":"Am Surg.","first-page":"958","article-title":"Successful management of occult pneumothorax without tube thorocostomy despite positive pressure ventilation","volume":"74","author":"Barrios\n\u00a0\nC","year":"2008"},{"issue":"8","key":"CIT0032","series-title":"Int J Sci 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