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

S Kepka,A L Parmentier,G Trebes,J B Pretalli,D Lauque,F Mauny,T Desmettre,J C Dalphin

doi:10.1186/s12873-018-0213-2

Abstract

BackgroundManagement 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.MethodsFrom 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.ResultsAmong 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%).ConclusionsOur 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.

Highlights

IntroductionEncouraging 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
Management of spontaneous pneumothorax (SP) is still subject to debate
Voisin et al reported this type of data, notably specifying that a pulmonologist could be contacted if necessary day and night [9]. These data would have been interesting and may have been influential in the choice and availability of ambulatory management. Despite several limitations, this multicentre study underlines the low level of implementation of outpatient management of PS in France, even though most patients with SP admitted to the emergency departments (ED) had no signs of gravity

Summary

Introduction

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. This report, based on data from the French national hospitalization database, did not inform about the effective first line treatment in the ED. Another multicenter study conducted in EDs in Australia did not provide any data concerning the type of equipment, the speciality of the physicians managing the patients, or the departments of hospitalization [11]. There exists a gap in knowledge concerning real-life conditions of SP management in the ED, in particular the role of ambulatory management and the type of interventions performed

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