MDCT quantification is the dominant parameter in decision-making regarding chest tube drainage for stable patients with traumatic pneumothorax

Abstract

It is commonly believed that the size of a pneumothorax is an important determinant of treatment decision, in particular regarding whether chest tube drainage (CTD) is required. However, the volumetric quantification of pneumothoraces has not routinely been performed in clinics. In this paper, we introduced an automated computer-aided volumetry (CAV) scheme for quantification of volume of pneumothoraces in chest multi-detect CT (MDCT) images. Moreover, we investigated the impact of accurate volume of pneumothoraces in the improvement of the performance in decision-making regarding CTD in the management of traumatic pneumothoraces. For this purpose, an occurrence frequency map was calculated for quantitative analysis of the importance of each clinical parameter in the decision-making regarding CTD by a computer simulation of decision-making using a genetic algorithm (GA) and a support vector machine (SVM). A total of 14 clinical parameters, including volume of pneumothorax calculated by our CAV scheme, was collected as parameters available for decision-making. The results showed that volume was the dominant parameter in decision-making regarding CTD, with an occurrence frequency value of 1.00. The results also indicated that the inclusion of volume provided the best performance that was statistically significant compared to the other tests in which volume was excluded from the clinical parameters. This study provides the scientific evidence for the application of CAV scheme in MDCT volumetric quantification of pneumothoraces in the management of clinically stable chest trauma patients with traumatic pneumothorax.

Management of computed tomography-detected pneumothorax in patients with blunt trauma: experience from a community-based hospital

“…In these patients, pneumothorax might not have been diagnosed if CT had not been performed, persisting as occult pneumothorax instead. (16,17) In all, 19 (63.3%) out of 30 patients were treated conservatively without chest tube insertion in our study. Other studies have reported that 48% of patients with occult pneumothorax were treated conservatively.…”

Management of traumatic pneumothorax in isolated blunt chest trauma

“…Furthermore, tube thoracostomy may bring along complications such as nonfunctioning or malposition of chest tube, wound infection, abdominal or thoracic injury and vascular trauma in 2-10% of the patients [4][5][6]. Advantages of minimally invasive surgery offered by VATS have oriented many institutions to accept this method as the preferred treatment for patients with chest trauma [14].…”

“…However, the optimal management for stable patients continues to be debated considering that complication and failure of inapropriate interventions may rate up to 30% [6].…”

Deep learning detection and quantification of pneumothorax in heterogeneous routine chest computed tomography

“…Next to clinical symptoms, the treatment decision can be partially supported by the pneumothorax extent or volume as measured on chest radiographs or computed tomography (CT) scans [4][5][6]. When the cause is spontaneous, a 'large' pneumothorax is defined as larger than 3 cm or than 15% of the volume of the hemithorax and requires aspiration [7].…”