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Observational Study
. 2019 Jan 11;19(1):4.
doi: 10.1186/s12873-018-0213-2.

How spontaneous pneumothorax is managed in emergency departments: a French multicentre descriptive study

S Kepka  1   2 , J C Dalphin  3   4 , J B Pretalli  5 , A L Parmentier  3   6 , D Lauque  7 , G Trebes  8 ; EXPPI study group; F Mauny  3   6 , T Desmettre  3   5
Collaborators, Affiliations
Observational Study

How spontaneous pneumothorax is managed in emergency departments: a French multicentre descriptive study

S Kepka et al. BMC Emerg Med. .

Abstract

Background: Management of spontaneous pneumothorax (SP) is still subject to debate. Although encouraging results of recent studies about outpatient management with chest drains fitted with a one-way valve, no data exist concerning application of this strategy in real life conditions. We assessed how SP are managed in Emergency departments (EDs), in particular the role of outpatient management, the types of interventions and the specialty of the physicians who perform these interventions.

Methods: From June 2009 to May 2013, all cases of spontaneous primary (PSP) and spontaneous secondary pneumothorax (SSP) from EDs of 14 hospitals in France were retrospectively included. First line treatment (observation, aspiration, thoracic drainage or surgery), type of management (admitted, discharged to home directly from the ED, outpatient management) and the specialty of the physicians were collected from the medical files of the ED.

Results: Among 1868 SP included, an outpatient management strategy was chosen in 179 PSP (10%) and 38 SSP (2%), mostly when no intervention was performed. Only 25 PSP (1%) were treated by aspiration and discharged to home after ED admission. Observation was the chosen strategy for 985 patients (53%). In 883 patients with an intervention (47%), it was performed by emergency physicians in 71% of cases and thoracic drainage was the most frequent choice (670 patients, 76%).

Conclusions: Our study showed the low level of implementation of outpatient management for PS in France. Despite encouraging results of studies concerning outpatient management, chest tube drainage and hospitalization remain preponderant in the treatment of SP.

Keywords: Aspiration; Emergency department; Observation; Outpatient management; Spontaneous pneumothorax; Thoracic drainage.

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Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the Comité consultatif sur le traitement de l’information en matière de recherche (CCTIRS) (agreement number 13564), and the Comité de Protection des Personnes (CPP) of the CHU of Besançon 13–06, and Commission nationale de l’informatique et des libertés (CNIL) (agreement number 913594), France. For this retrospective study, the Ethics Committee did not require written informed consent but a non-opposition was verified for every patient. Patients who do not agree for their data to be used at a later date for research purposes can opt out by signaling their opposition; otherwise, in the absence of opposition, patients are deemed to have consented.

Consent for publication

Consent to publish is not applicable in this study.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Management of Primary Spontaneous Pneumothorax in ED
Fig. 2
Fig. 2
Management of Secondary Spontaneous Pneumothorax in ED
See this image and copyright information in PMC

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