Primary spontaneous pneumothorax—the role of the emergency observation unit

• Published in: The American journal of emergency medicine Vol. 29; no. 3; pp. 293 - 298
• Main Authors: Kuan, Win Sen, Lather, Kanwar Sudhir, Mahadevan, Malcolm
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.2011; Elsevier; Elsevier Limited
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Biopsy, Fine-Needle; Chest Tubes; Chi-Square Distribution; Confidence intervals; Disease; Drainage; Emergency; Emergency and intensive care: techniques, logistics; Emergency medical care; Emergency Service, Hospital; Female; Hospitals; Humans; Intensive care medicine; Intensive care unit. Emergency transport systems. Emergency, hospital ward; Length of Stay; Male; Medical sciences; Oxygen therapy; Pneumothorax - prevention & control; Pneumothorax - therapy; Retrospective Studies; Secondary Prevention; Treatment Outcome; Young Adult; Pneumothorax; Intensive care; Effusion; Respiratory disease; Hospital ward; Pleural disease; Resuscitation
• ISSN: 0735-6757; 1532-8171; 1532-8171
• DOI: 10.1016/j.ajem.2009.11.005

The objective of this study was to compare an expedited 24-hour management pathway against traditional inpatient ward management of patients with primary spontaneous pneumothorax (PSP) and recurrent spontaneous pneumothorax (RSP). This was a retrospective chart review of all patients who presented with either PSP or RSP to an urban tertiary university hospital in 2007. Eighty-two patients were included in the study, of which approximately a third (27) were managed in the emergency department observation unit (EDOU). Five of the EDOU patients were admitted to the ward. Emergency department observation unit treatment failures as defined by recurrences within a week were comparable to those managed in the ward. One of 5 PSP patients receiving only oxygen therapy managed in the EDOU had their pneumothorax recur within a week on discharge, whereas none of the 15 receiving needle aspiration recurred within a week. For the RSP patients managed in the EDOU, 1 of 3 managed with oxygen therapy alone and discharged recurred within a week, whereas with needle aspiration, 1 of 4 recurred within a week. The success rate of aspiration in our study was comparable with that of published rates (75% versus 50%-60%). Small to moderate PSPs can be safely and efficiently managed within 24 hours in an EDOU.