Prevalence of tension pneumothorax in fatally wounded combat casualties

Background: Tension pneumothorax is a potential cause of death in victims of penetrating chest trauma, but little is known about its actual prevalence. Methods: Data that are part of the Vietnam Wound Data and Munitions Effectiveness Team study were analyzed to address this question. Radiographs of 978 casualties were examined for evidence of tension pneumothorax using standard radiologic criteria such as pleural separation, displacement of the mediastinum and diaphragm, trachea deviation, and compression of the contralateral lung Results: Some or all of the radiographic changes were found in 198 casualties. Autopsy evidence indicated that 79 of these casualties died solely due to a chest wound. The fatal chest injury involved only the lungs in 55 casualties and caused a tension pneumothorax in 26. Fifteen of the 26 lived long enough to receive first aid from a medic or corps-man. Conclusion: Tension pneumothorax was the cause of death in 3 to 4% of fatally wounded combat casualties. Some may be temporarily helped by battlefield thoracentesis.