In some patients, it may be preferable to radiologically confirm and localize tension pneumothorax before subjecting the patient to potential morbidities arising from decompression. However, this consideration should be limited to patients who are awake, stable, not in advanced stages of tension and when an immediate chest film can be obtained, with facilities to perform urgent decompression if needed.
Serial chest radiographs every 6hrs on the first day after injury to rule out pneumothorax is ideal, but two or three chest X-ray taken every 4-6hrs are sufficient.