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Introduction: The cooccurrence of a traumatic hemothorax (HTX) and pneumothorax (PTX) is extremely common (70%). Prior work shows the safety of observing small HTX (≤300 cubic centimeters) and PTX (≤35 mm) in isolation. Accordingly, we sought to assess the safety of observation of concurrent small hemopneumothorax(HPTX)., Methods: We conducted a single-center retrospective study from 2015 to 2021 at a level I trauma center. Patients with a computed tomography (CT) scan confirmed that HPTXwas included in the study. Exclusion criteria included tube thoracostomy (TT) prior to CT scan, TT placement for rib fixation, PTX>35 mm, HTX>300 cubic centimeters, and death within 72 h of admission. The study group was stratified into either initial observation or early TT, which is defined as TT placement immediately after initial CT scan. Primary outcome was observation failure., Results: A total of 353 patients met the inclusion criteria, of whom 261 (74%) were initially observed. The initial observation cohort had a lower pulmonary morbidity rate (9% versus 14%; P = 0.04) and a shorter hospital (7 versus 10 d, P < 0.001) and intensive care unit (2 versus 4 d, P = 0.01) length of stay (LOS) when compared to those with initial TT placement. Sixty-eight (26%) patients failed observation, with a worsening HTXon repeat imaging (45%) being the most common reason. Compared to those who received an early TT, those who failed observation had a similar pulmonary morbidity and need for video-assisted thoracoscopic surgery, TT duration, LOS, readmission, and mortality rates., Conclusions: Initial observation of concurrent small traumatic HPTX had a lower pulmonary morbidity and LOS but was found to have a clinically significant failure rate. Patients who failed observation had similar outcomes to those who received an early TT., (Copyright © 2024 Elsevier Inc. All rights reserved.)