Background Traumatic pneumothoraces are a common consequence of major trauma. Despite this, there is a paucity of literature regarding their optimal management, including the role of conservative treatment. The aim of this study was to assess the treatment, complications and outcomes of traumatic pneumothoraces in patients presenting to a Major Trauma Centre.

Methods The prospectively collected Trauma Audit :

and Research Network (TARN) database was used to identify all patients presenting with traumatic pneumothoraces to a UK Major Trauma Centre from April 2012 to December 2016. Demographics, mechanism of injury, injury severity score (ISS), management and outcomes were analysed.

Results 602 patients were included in study period. Mean age 48 (SD 22) with 73% male. Mean ISS was 26 and inpatient mortality 9%. Of the 602 traumatic pneumothoraces, 277/602 (46%) were initially treated conservatively. 252/277 (90%) of this cohort did not require subsequent chest tube insertion, including the majority, 56/62 (90%), of patients on admission positive pressure ventilation (PPV). Hazard ratio for failure of conservative management showed no difference between the ventilated and non-ventilated patients (HR 1.1 p 0.84). Only the presence of large hemothorax was associated with increased likelihood of failure of conservative management.

Conclusions In the largest observational study of traumatic pneumothoraces published to date, over 90% of patients whose pneumothorax was managed conservatively never required subsequent tube drainage. Importantly, this also applies to patients requiring PPV, with no significant increased risk of failure of expectant management. This data supports a role for conservative management in traumatic pneumothoraces.