Chest
Original ResearchSpontaneous PneumothoraxOutcomes of Emergency Department Patients Treated for Primary Spontaneous Pneumothorax
Section snippets
Study Design
This was a retrospective observational cohort study that was conducted by explicit medical record review.5
Setting
The study was conducted in two community teaching hospitals in Melbourne, VIC, Australia.
Participants
The participants in the study consisted of a consecutive sample of adult ED patients (age range, 16 to 60 years) with confirmed PSP who were treated from 1996 to 2005 and were identified from an ED administrative database. Patients with secondary iatrogenic and traumatic pneumothoraces were excluded
Results
There were 203 episodes of PSP in 154 patients. Patient characteristics are shown in Table 1. Fifty-five percent of patients were documented as being current smokers. PSP size ranged from 5 to 100%, with 57% occurring on the left side. In 38% of episodes (78 of 203 episodes), patients reported having experienced a previous PSP; 67% of episodes (51 episodes) occurred on the same side, and a further 12% of episodes (9 episodes) occurred on both sides. It was not possible to calculate the
Discussion
The optimal management strategy for clinically well patients with PSP remains to be defined. Guidelines vary in their recommendations (Table 2), and a robust evidence base to inform practice is lacking.
Our data suggest that conservative management is successful in a high proportion of selected patients (79%), including those with larger PSPs. There were no emergent interventions, suggesting that this approach is also safe. This is only the second series of > 50 patients reporting outcomes for
Conclusion
These data suggest that outpatient observation is an effective initial treatment strategy in selected patients with PSP. They support the inclusion of an observation arm in planned prospective studies comparing management approaches.
References (13)
- et al.
Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement
Chest
(2001) - et al.
Chart reviews in emergency medicine research: where are the methods?
Ann Emerg Med
(1996) - et al.
Civilian spontaneous pneumothorax: treatment options and long-term results
Chest
(1989) - et al.
BTS guidelines for the management of spontaneous pneumothorax
Thorax
(2003) - et al.
Guidelines Belgian Society of Pulmonology: guidelines on the management of spontaneous pneumothorax
Acta Chir Belg
(2005) Management of primary spontaneous pneumothorax: is the best evidence clearer fifteen years on?
Emerg Med Australas
(2007)
Cited by (48)
Utilization and Outcomes of Observation for Spontaneous Pneumothorax at an Integrated Health System
2023, Journal of Surgical ResearchGuidelines for management of patients with primary spontaneous pneumothorax
2023, Revue des Maladies RespiratoiresThe Primary Spontaneous Pneumothorax trial: A critical appraisal from the surgeon's perspective
2021, Journal of Thoracic and Cardiovascular SurgeryComparison of efficiency and safety of conservative versus interventional management for primary spontaneous pneumothorax: A meta-analysis
2021, American Journal of Emergency MedicineCitation Excerpt :All included studies compared conservative management with interventional treatment, four studies with chest-tube drainage, one study with needle aspiration, one study with chest-tube drainage and needle aspiration, one study with chest-tube drainage and VATS and one study with Thoracotomy and VATS. In general, six included studies involving 890 patients reported success rates [7,11,12,14,15,17]. There was no statistically significant difference in success rates between conservative management (258 of 292 [88.36%]) group and interventional management (505 of 598 [84.45%]) group (risk ratio 1.05, 95% confidence interval 0.94 to 1.17, I2 = 69.1%; Fig. 2).
The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).