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IntroductionTraumatic tension pneumothorax (TPTX) is a life threatening condition, but literature describing this condition specifically in developing countries is scarce.Materials and methodsWe conducted a retrospective review of 115 patients with a TPTX, managed over a 4-year period in a high volume trauma service in South Africa.ResultsA total of 118 TPTXs were identified in 115 patients. Eighty-nine percent (102/115) were males, and the mean age was 26 years (SD ± 6 years). Seventy-four percent (87/118) of all TPTXs occurred on the left side. The mechanisms of injury were penetrating in 71 % (82/115) [82 stab injuries], and blunt in 29 % (33/115) [31 road traffic accidents and 2 assaults]. Ninety-seven percent (111/115) of patients presented directly to our unit, while 3 % (4/115) were referrals from other hospitals. Fifteen percent (17/115) of needle decompressions were performed in the pre-hospital setting while the remaining 85 % (98/115) were performed on arrival (73 were recognised clinically and 25 were not). Of the 25 TPTXs that were not recognised clinically on initial assessment, 12 were discovered on CXR, 8 on CT scans and 5 in the operating room (OR). The overall mortality was 9 % (10/115) [7 in CXR, 2 in CT, 1 in OR]. None of the patients who had the TPTXs identified on initial clinical assessment died (0/73), compared with those who were missed on initial clinical assessment, in which the mortality was significantly higher at 40 % (10/25), (p < 0.001).ConclusionsPenetrating injuries accounted for the majority of TPTXs seen in our setting. Clinical recognition of the entity may be challenging and delayed recognition is associated with significant mortality.

Original publication





European journal of trauma and emergency surgery : official publication of the European Trauma Society

Publication Date





55 - 59


Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu Natal, Pietermaritzburg, South Africa.


Humans, Pneumothorax, Thoracic Injuries, Wounds, Nonpenetrating, Wounds, Penetrating, Diagnostic Errors, Tomography, X-Ray Computed, Radiography, Thoracic, Decompression, Surgical, Thoracostomy, Retrospective Studies, Cohort Studies, Adult, Emergency Service, Hospital, Emergency Medical Services, South Africa, Female, Male, Young Adult