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Spontaneous pneumothorax; a multicentre retrospective analysis of emergency treatment, complications and outcomes
Author(s) -
Brown S. G. A.,
Ball E. L.,
Macdonald S. P. J.,
Wright C.,
McD Taylor D.
Publication year - 2014
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.12398
Subject(s) - medicine , pneumothorax , emergency department , retrospective cohort study , surgery , confidence interval , pulse oximetry , anesthesia , psychiatry
Abstract Background Spontaneous pneumothorax can be managed initially by observation, aspiration or chest drain insertion. Aims To determine the clinical features of spontaneous pneumothorax in patients presenting to the emergency department ( ED ), interventions, outcomes and potential risk factors for poor outcomes after treatment. Methods Retrospective chart review from ED of three major referral and two general hospitals in A ustralia of presentations with primary spontaneous pneumothorax ( PSP ) or secondary spontaneous pneumothorax ( SSP ). Main outcomes were prolonged air leak (>5 days) and pneumothorax recurrence within 1 year. Results We identified 225 people with PSP and 98 with SSP . There were no clinical tension pneumothoraces with hypotension. Hypoxaemia (haemoglobin oxygen saturation measured by pulse oximetry ≤92%) occurred only in SSP and in older patients (age >50 years) with PSP . Drainage was performed in 150 (67%) PSP and 82 (84%) SSP . Prolonged air leak occurred in 16% (95% confidence interval 10–23%) of PSP and 31% (21–42%) of SSP . Independent risk factors for prolonged drainage were non‐asthma SSP and pneumothorax size >50%. Complications were recorded in 11% (7.5–16%) of those having drains inserted. Recurrences occurred in 5/91 (5%, 1.8–12%) of those treated without drainage versus 40/232 (17%, 13–23%) of those treated by drainage, of which half occurred in the first month after drainage. Conclusion Pneumothorax drainage is associated with substantial morbidity including prolonged air leak. As PSP appears to be well tolerated in younger people even with large pneumothoraces, conservative treatment in this subgroup may be a viable option to improve patient outcomes, but this needs to be confirmed in a clinical trial.