Management of pneumothoraces cases in a district general hospital in London

Abstract

<b>Introduction:</b> Spontaneous pneumothorax is a significant health problem. The 2010 BTS guidelines&nbsp;recommends needle aspiration (NA) as the initial management in most cases, with intercoastal chest tube drainage (ICD) being reserved for failed NA and large or symptomatic secondary pneumothoraces. The management of primary pneumothoraces with a rocket vent, an ambulatory device that is associated with reduced duration of stay in the previous trials&nbsp;is yet to be included in the guidelines. <b>Aims:</b> We sought to examine the cases of pneumothoraces seen in a large district general hospital based in London, United Kingdom. The main outcome was initial management and the need for re-intervention for a failed procedure. The secondary outcome was the duration of the hospital stay. <b>Methods:</b> We retrospectively analysed all cases of pneumothoraces presenting to the South London district general hospital Queen Elizabeth Hospital, Woolwich from January 2020 to May 2021. <b>Results:</b> A total of 37 eligible cases (18 primary, 19 secondary) were identified, out of which 34 cases followed BTS guidelines. Among primary cases, ten and among secondary cases three underwent needle aspiration. A total of twelve out of thirteen with NA had failed procedures requiring ICD. The length of stay remained comparable in both groups of failed NA and ICD (3.9 vs 4.5 days in primary cases and (6.7 vs 8.4) in secondary cases after exclusion of one complicated case which alone required 48 days of hospitalisation. <b>Conclusion:</b> Our results indicate that the success rate of NA is poor. Ambulatory management of primary cases with less invasive rocket vent would be desirable but its feasibility in a district general hospital is questionable due to lack of resources.