Trauma patients with blunt (and maybe penetrating) chest injury, who had a pneumothorax ≤35mm on CT did well without a thoracostomy tube, with only 9% failing observation only.
In this systematic review and meta-analysis, no single aspect of the physical examination, imaging, or LRINEC score had high enough sensitivity to exclude necrotizing soft tissue infections. Contrast CT performed the best, but it was only 94.3% sensitive at best. If you have a high clinical suspicion, early surgical consultation is necessary for definitive diagnosis and management.
In opioid naïve patients 13-21 years of age, persistent opioid use was found in 4.8% of the post-surgical group vs 0.1% of those in the non-surgical group. Procedures associated with the highest risk of persistent opioid use were cholecystectomy and colectomy. Independent risk factors included older age, female sex, diagnoses of substance use disorder and chronic pain.