• S C Chen, J F Markmann, D R Kauder, and C W Schwab.
• Department of Emergency Medicine, National Taiwan University Hospital, Taipei.
• J Trauma. 1997 Jan 1; 42 (1): 86-9.

ObjectiveTo determine the frequency and extent of hemothorax, pneumothorax, and hemopneumothorax missed by auscultation in penetrating chest injury.DesignA retrospective chart and chest radiograph review.Materials And MethodsOne hundred and eighteen patients suffering penetrating chest injuries during 1993 were studied. A missed auscultation was defined as a patient with normal breath sounds but shown by chest radiograph to have a hemothorax, pneumothorax, or hemopneumothorax. The amount of hemothorax was recorded after chest tube placement or at thoracotomy. The degree of pneumothorax was determined by Rhea's method.ResultsSeventy-one patients (60%) had a hemothorax, pneumothorax, or hemopneumothorax. Auscultation to detect hemothorax, pneumothorax, or hemopneumothorax had a sensitivity of 58%, a specificity of 98%, and a positive predictive value of 98%. Thirty of 71 patients (42%) were found to have pleural space blood or air missed by auscultation. Twelve patients (41%) had a hemopneumothorax, 11 patients (36%) had hemothorax, and seven patients (23%) had pneumothorax. Auscultation missed hemothorax up to 600 mL, pneumothorax up to 28%, and hemopneumothorax up to 800 mL and 28%.ConclusionHemopneumothorax and hemothorax are the conditions most likely to be missed by auscultation, especially in patients with gunshot wounds. Auscultation has a high positive predictive value because it indicates injury with a fair degree of certainty; however, a negative auscultation does not rule out injury.

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