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Emerg Med J. 2007 December; 24(12): 865.
PMCID: PMC2658373

Response: tension pneumothorax prevalence grossly exaggerated

In our article we stated:

  1. “tension pneumothorax is a rare prehospital event, particularly in blunt trauma”
  2. “it is difficult to assess the exact numbers accurately as thoracocentesis is often performed in the absence of a true tension pneumothorax”
  3. “recent studies show a prevalence of less than 6%”.

We believe the comments in your letter concur with this.

In your excellent review of tension pneumothorax in the EMJ in 2005 you also described the same incidence, stating “TPT was confirmed (hiss of air on decompression) in 5.4% of major trauma patients (64% whom were ventilated) treated by prehospital doctors in London”.1

With regards to your comment of hoping that awareness of the very low prevalence of tension pneumothorax will help in “stemming the tide of iatrogenic needle induced pneumothorax”, we would agree that unnecessary needle decompression does occur in practice. However, prehospital practitioners should not believe that tension pneumothorax is so unlikely that they fail to treat a reversible life threatening condition in the individual patient who is deteriorating or is peri‐arrest following a chest injury. We would rather an iatrogenic simple pneumothorax than a patient who dies from a simple reversible cause because the practitioner believed it to be so rare.


Competing interests: None declared.


1. Leigh‐Smith S, Harris T. Tension pneumothorax—time for a rethink? Emerg Med J 2005. 228–16.16 [PMC free article] [PubMed]

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