Selective conservatism in the management of XXXX remains appropriate in the 21st century.

@entity1 @entity5274 @entity130
INTRODUCTION: Selective conservatism for @entity130 is well established but the emergence of new technologies may cause management strategies to continue to evolve. METHODS: A retrospective study was conducted on @entity130 @entity1 managed in a single institution in South Africa over a 4-year period to determine the appropriateness of our current policy of selective conservatism. RESULTS: A total of 1,239 @entity1 were included in the study; 112 required an emergency thoracotomy, 125 were admitted for observation and 1,002 required a @entity5274 ( @entity5274 ). Ninety-one per cent of the @entity1 were male and the median age was 24 years. Seventy-five per cent of the cases were penetrating @entity130 and the remaining were @entity130 . The indications for @entity5274 were pneumothorax (PTX) (n=382, 38%), haemothorax (HTX) (n=300, 30%) and haemopneumothorax (HPTX) (n=320, 32%). A total of 13% (127/1,002) of all chest x-rays (CXR) following tube removal demonstrated residual pathologies that precluded immediate discharge: 32 (8%) in Group A (PTX), 44 (15%) in Group B (HTX) and 51 (16%) in Group C (HPTX). All 32 @entity1 in Group A were simply observed and did not require further intervention. In Group B, 17 @entity1 required repeat TTs and 27 required video assisted thoracoscopic surgery (VATS) for clearance of residual HTX. Twenty-nine @entity1 in Group C required repeat TTs and twenty-two required VATS. CONCLUSIONS: The vast majority of @entity1 with @entity130 can be managed conservatively with @entity5274 alone. Residual pathology appeared to be lowest in @entity1 with a PTX, which seldom requires treatment, while only a minority of @entity1 required repeat TTs or VATS for a retained HTX. Selective conservatism is still appropriate in the current era in a developing world setting.
