RT Journal Article
SR Electronic
T1 Primary spontaneous pneumothorax size: Comparison of international guidelines
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP p460
VO 38
IS Suppl 55
A1 Shehnoor Tarique
A1 Jonathan Noble
A1 Alice Gallen
A1 Mathew Jones
YR 2011
UL http://erj.ersjournals.com/content/38/Suppl_55/p460.abstract
AB Background: Size estimation is central to decisions on management of Primary Spontaneous Pneumothorax (PSP). International guidelines exhibit a lack of consensus on PSP sizing. We aimed to study PSP size using established techniques (Rhea, Collins and Light method) and compare size classification and suggested management of American (ACCP), Belgian (BSP) and British (BTS) guidelines.Methods: Retrospective cohort study of all patients admitted with PSP to two centres in our institution between January 2007 and July 2010. Initial inspiratory chest x-rays (digital images with size calibration) were reviewed to quantify PSP size using BTS, ACCP, BSP, Collins, Rhea and Light's methods. Data was analysed using descriptive statistics with kappa analysis for agreement between guidelines.Results: 105 patients were studied, median age 27 years, 72% male. Median PSP size was 58% (Collins' method), 39% (Rhea) and 51% (Light). BTS classification defined 56% PSPs as large compared to 72% (BSP) and 78% (ACCP). Agreement between all three guidelines was seen in 61/105 (58%).Paired kappa agreement between ACCP and BTS guidelines was 0.2, ACCP and BSP 0.44 and BTS and BSP 0.46. 21% of patients with complete lung dehiscence (large PSP by BSP guidelines) had a small PSP by BTS guidelines. 5% with partial lung dehiscence (small PSP by BSP guidelines) had a large PSP by the BTS classification.Conclusion: Most patients with PSP in this study present with a large pneumothorax according to all three guidelines. There remain marked discrepancies in suggested treatment strategies, with at best moderate agreement between BTS and BSP guidelines. International consensus is needed to unify treatment strategies in PSP management.