Current practice and attitudes in emergency department management of primary spontaneous pneumothorax in Australia and New Zealand: a scenario-based/survey

IF 1.8 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Internal Medicine Journal Pub Date : 2025-03-31 DOI:10.1111/imj.70054

Anne-Maree Kelly, Sanjeevan Muruganandan, Peter Jones, Gerben Keijzers, Fran Kinnear, Peter Cameron, Arash Badiei, YC Gary Lee, Julian A Smith, Emma Ball, Ethan Bacon, Roland Bammer, Diana Egerton-Warburton

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引用次数: 0

Abstract

Background

Management of primary spontaneous pneumothorax (PSP) has long been contentious.

Aims

To identify the factors influencing interventional versus conservative management and to assess current practice patterns for moderate-to-large PSP in emergency department (ED) patients.

Methods

Anonymous online survey of emergency medicine, respiratory medicine and thoracic surgery specialists and trainees in Australia and New Zealand. Data collected included rating the decision-making importance of potential drivers of interventional versus conservative management for PSP, initial management preference for stable patients with moderate-large PSP based on three X-ray-based scenarios (one moderate-large, one almost total collapse without mediastinal shift and one large with mediastinal shift) and awareness of evidence and current guidelines for the management of PSP.

Results

There were 456 responses; 85.5% were from Australia. The most commonly reported factors influencing treatment decision-making were vital signs (96.7%) and patient-reported dyspnoea (84.3%). There was variation between specialty groups in initial treatment preference for all scenarios (P < 0.001) and a reduction in preference for conservative treatment as the magnitude of radiological features increased (93.8% vs 61.5% vs 32.1% respectively). Guideline recommendation awareness was low except for the 2023 British Thoracic Society guideline (60.4%).

Conclusion

This study demonstrates variation of opinion regarding the initial management of stable patients with moderate to large PSP and an increasing preference for intervention as the magnitude of radiological features increases. Guideline awareness was low, highlighting the need for an evidence-based approach to PSP management in the ED that is widely understood and accepted across speciality groups and that prioritises patient symptoms over X-ray findings.

查看原文本刊更多论文

澳大利亚和新西兰急诊科管理原发性自发性气胸的当前做法和态度：一项基于场景的调查。

背景：原发性自发性气胸（PSP）的治疗一直存在争议。目的：确定影响介入治疗与保守治疗的因素，并评估急诊科（ED）患者中重度PSP的当前实践模式。方法：对澳大利亚和新西兰的急诊医学、呼吸医学和胸外科专科医生和培训生进行匿名在线调查。收集的数据包括评估PSP介入治疗与保守治疗的潜在驱动因素的决策重要性，基于三种基于x线的情况（一种中度大、一种几乎完全塌陷但没有纵隔移位和一种大纵隔移位），对稳定的中重度PSP患者的初始治疗偏好，以及对PSP治疗的证据和现行指南的认识。结果：共回复456份；85.5%来自澳大利亚。最常见的影响治疗决策的因素是生命体征（96.7%）和患者报告的呼吸困难（84.3%）。结论：本研究表明，对于中度至大型PSP稳定患者的初始治疗，不同专科组对干预的偏好存在差异，随着影像学特征的增加，对干预的偏好也在增加。指南的认知度较低，强调了在急诊科采用循证方法进行PSP管理的必要性，这种方法在各专科群体中被广泛理解和接受，并且优先考虑患者的症状而不是x线表现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Internal Medicine Journal 医学-医学：内科

CiteScore

3.50

自引率

4.80%

发文量

600

审稿时长

3-6 weeks

期刊介绍： The Internal Medicine Journal is the official journal of the Adult Medicine Division of The Royal Australasian College of Physicians (RACP). Its purpose is to publish high-quality internationally competitive peer-reviewed original medical research, both laboratory and clinical, relating to the study and research of human disease. Papers will be considered from all areas of medical practice and science. The Journal also has a major role in continuing medical education and publishes review articles relevant to physician education.